"Notes"	"VAERS ID"	"VAERS ID Code"	"Symptoms"	"Symptoms Code"	"Age"	"Age Code"	Adverse Event Description
	"0936805-1"	"0936805-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient received the vaccine on 12/22/20 without complication. It was reported today that the patient was found unresponsive and subsequently expired at home on 1/11/21."
	"0936805-1"	"0936805-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"18-29 years"	"18-29"	"Patient received the vaccine on 12/22/20 without complication. It was reported today that the patient was found unresponsive and subsequently expired at home on 1/11/21."
	"0943397-1"	"0943397-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"On day due for 2nd dose, Patient was found unresponsive at work in the hospital.  Patient pupils were fixed and dilated.  Full ACLS was initiated for 55 minutes with multiple rounds of bicarb, calcium chloride, magnesium, and epinephrine. Patient was intubated.  Patient continued into V. Fib arrest and was shocked multiple times."
	"0943397-1"	"0943397-1"	"CARDIOVERSION"	"10007661"	"18-29 years"	"18-29"	"On day due for 2nd dose, Patient was found unresponsive at work in the hospital.  Patient pupils were fixed and dilated.  Full ACLS was initiated for 55 minutes with multiple rounds of bicarb, calcium chloride, magnesium, and epinephrine. Patient was intubated.  Patient continued into V. Fib arrest and was shocked multiple times."
	"0943397-1"	"0943397-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"On day due for 2nd dose, Patient was found unresponsive at work in the hospital.  Patient pupils were fixed and dilated.  Full ACLS was initiated for 55 minutes with multiple rounds of bicarb, calcium chloride, magnesium, and epinephrine. Patient was intubated.  Patient continued into V. Fib arrest and was shocked multiple times."
	"0943397-1"	"0943397-1"	"PUPIL FIXED"	"10037515"	"18-29 years"	"18-29"	"On day due for 2nd dose, Patient was found unresponsive at work in the hospital.  Patient pupils were fixed and dilated.  Full ACLS was initiated for 55 minutes with multiple rounds of bicarb, calcium chloride, magnesium, and epinephrine. Patient was intubated.  Patient continued into V. Fib arrest and was shocked multiple times."
	"0943397-1"	"0943397-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"18-29 years"	"18-29"	"On day due for 2nd dose, Patient was found unresponsive at work in the hospital.  Patient pupils were fixed and dilated.  Full ACLS was initiated for 55 minutes with multiple rounds of bicarb, calcium chloride, magnesium, and epinephrine. Patient was intubated.  Patient continued into V. Fib arrest and was shocked multiple times."
	"0958443-1"	"0958443-1"	"COMPLETED SUICIDE"	"10010144"	"1-2 years"	"1-2"	"death by suicide Narrative:  death by suicide; 12/26/20, self inflicted gun shot wound; found deceased by family member"
	"0958443-1"	"0958443-1"	"DEATH"	"10011906"	"1-2 years"	"1-2"	"death by suicide Narrative:  death by suicide; 12/26/20, self inflicted gun shot wound; found deceased by family member"
	"0958443-1"	"0958443-1"	"GUN SHOT WOUND"	"10018794"	"1-2 years"	"1-2"	"death by suicide Narrative:  death by suicide; 12/26/20, self inflicted gun shot wound; found deceased by family member"
	"0960841-1"	"0960841-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired."
	"0960841-1"	"0960841-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"18-29 years"	"18-29"	"Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired."
	"0960841-1"	"0960841-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired."
	"0960841-1"	"0960841-1"	"LUNG INFILTRATION"	"10025102"	"18-29 years"	"18-29"	"Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired."
	"0960841-1"	"0960841-1"	"PYREXIA"	"10037660"	"18-29 years"	"18-29"	"Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired."
	"1033873-1"	"1033873-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"PATIENT PASSED AWAY ON 2-1-2021"
	"1034146-1"	"1034146-1"	"UNEVALUABLE EVENT"	"10062355"	"18-29 years"	"18-29"	"ARRIVED AT EVENT, CONSENT FORM COMPLETED, DID NOT REPORT HE HAD BEEN ILL, DID NOT REPORT THAT HE TOOK ANY FEVER REDUCING MEDICATIONS"
	"1071935-1"	"1071935-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"18-29 years"	"18-29"	"Patient received the vaccine around 11 am.  He hadn't been feeling well (headache, dizziness) per report and initially called in to work.  He then decided to come to work and was found down in a patient bathroom during his shift on our Facility while taking care of a patient (he was a nurse aid).  Patient was coded and the team and was transferred to our Facility ED.   He expired 3/3 2112"
	"1071935-1"	"1071935-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient received the vaccine around 11 am.  He hadn't been feeling well (headache, dizziness) per report and initially called in to work.  He then decided to come to work and was found down in a patient bathroom during his shift on our Facility while taking care of a patient (he was a nurse aid).  Patient was coded and the team and was transferred to our Facility ED.   He expired 3/3 2112"
	"1071935-1"	"1071935-1"	"DIZZINESS"	"10013573"	"18-29 years"	"18-29"	"Patient received the vaccine around 11 am.  He hadn't been feeling well (headache, dizziness) per report and initially called in to work.  He then decided to come to work and was found down in a patient bathroom during his shift on our Facility while taking care of a patient (he was a nurse aid).  Patient was coded and the team and was transferred to our Facility ED.   He expired 3/3 2112"
	"1071935-1"	"1071935-1"	"FALL"	"10016173"	"18-29 years"	"18-29"	"Patient received the vaccine around 11 am.  He hadn't been feeling well (headache, dizziness) per report and initially called in to work.  He then decided to come to work and was found down in a patient bathroom during his shift on our Facility while taking care of a patient (he was a nurse aid).  Patient was coded and the team and was transferred to our Facility ED.   He expired 3/3 2112"
	"1071935-1"	"1071935-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Patient received the vaccine around 11 am.  He hadn't been feeling well (headache, dizziness) per report and initially called in to work.  He then decided to come to work and was found down in a patient bathroom during his shift on our Facility while taking care of a patient (he was a nurse aid).  Patient was coded and the team and was transferred to our Facility ED.   He expired 3/3 2112"
	"1071935-1"	"1071935-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"Patient received the vaccine around 11 am.  He hadn't been feeling well (headache, dizziness) per report and initially called in to work.  He then decided to come to work and was found down in a patient bathroom during his shift on our Facility while taking care of a patient (he was a nurse aid).  Patient was coded and the team and was transferred to our Facility ED.   He expired 3/3 2112"
	"1071935-1"	"1071935-1"	"WEIGHT INCREASED"	"10047899"	"18-29 years"	"18-29"	"Patient received the vaccine around 11 am.  He hadn't been feeling well (headache, dizziness) per report and initially called in to work.  He then decided to come to work and was found down in a patient bathroom during his shift on our Facility while taking care of a patient (he was a nurse aid).  Patient was coded and the team and was transferred to our Facility ED.   He expired 3/3 2112"
	"1076949-1"	"1076949-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient admitted on 2/21/21 and died in hospital on 2/22/2021.  Patient had a significant, lifelong  underlying medical condition."
	"1078352-1"	"1078352-1"	"CHEST PAIN"	"10008479"	"18-29 years"	"18-29"	"Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home."
	"1078352-1"	"1078352-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home."
	"1078352-1"	"1078352-1"	"FATIGUE"	"10016256"	"18-29 years"	"18-29"	"Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home."
	"1078352-1"	"1078352-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home."
	"1078352-1"	"1078352-1"	"PAIN"	"10033371"	"18-29 years"	"18-29"	"Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home."
	"1078352-1"	"1078352-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"18-29 years"	"18-29"	"Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home."
	"1082804-1"	"1082804-1"	"COMPLETED SUICIDE"	"10010144"	"18-29 years"	"18-29"	"Patient committed suicide the morning of March 2, 2021. He stepped in front of a truck on a highway.  I consulted with pharmacy and they said that I should report even if the 2 most likely have nothing to do with each other."
	"1088723-1"	"1088723-1"	"BLOOD TEST"	"10061726"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1088723-1"	"1088723-1"	"BODY TEMPERATURE INCREASED"	"10005911"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1088723-1"	"1088723-1"	"CHEST X-RAY"	"10008498"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1088723-1"	"1088723-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1088723-1"	"1088723-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1088723-1"	"1088723-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1088723-1"	"1088723-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1088723-1"	"1088723-1"	"INTENSIVE CARE"	"10022519"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1088723-1"	"1088723-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"18-29 years"	"18-29"	"Patient had 2nd COVID vaccine on 2/21/2021. He started having a temperature  on 2/24/2021. Patient then started having trouble breathing. We took him to hospital. He was admitted on 2/25/2021. He steadily declined and was sent to ICU and died on March 1, 2021."
	"1095634-1"	"1095634-1"	"BLOOD TEST"	"10061726"	"18-29 years"	"18-29"	"2nd injection given on 2/19/2021 death 2/27/21"
	"1095634-1"	"1095634-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"2nd injection given on 2/19/2021 death 2/27/21"
	"1095634-1"	"1095634-1"	"MAGNETIC RESONANCE IMAGING"	"10078223"	"18-29 years"	"18-29"	"2nd injection given on 2/19/2021 death 2/27/21"
	"1105115-1"	"1105115-1"	"ABSCESS LIMB"	"10050473"	"18-29 years"	"18-29"	"Resident did not express having any symptoms, the only thing that the POC observed abscesses in the arm, groin, thigh and knees after the first vaccination. After the second dose, he was hypoactive. On 2/27 at about 3:30 am he asked him to turn on his side, between 4 am and 5 am POC went to the room I notice it strange, because his head was wrapped in the sheet. When the POC removed the sheet, she observed that her mouth and nose were full of secretions. So he turned it and he himself did not react. He called the emergency who certifies that he had no vital signs. (emergency arrives within 5:45 am to 6:00 am)"
	"1105115-1"	"1105115-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Resident did not express having any symptoms, the only thing that the POC observed abscesses in the arm, groin, thigh and knees after the first vaccination. After the second dose, he was hypoactive. On 2/27 at about 3:30 am he asked him to turn on his side, between 4 am and 5 am POC went to the room I notice it strange, because his head was wrapped in the sheet. When the POC removed the sheet, she observed that her mouth and nose were full of secretions. So he turned it and he himself did not react. He called the emergency who certifies that he had no vital signs. (emergency arrives within 5:45 am to 6:00 am)"
	"1105115-1"	"1105115-1"	"DECREASED ACTIVITY"	"10011953"	"18-29 years"	"18-29"	"Resident did not express having any symptoms, the only thing that the POC observed abscesses in the arm, groin, thigh and knees after the first vaccination. After the second dose, he was hypoactive. On 2/27 at about 3:30 am he asked him to turn on his side, between 4 am and 5 am POC went to the room I notice it strange, because his head was wrapped in the sheet. When the POC removed the sheet, she observed that her mouth and nose were full of secretions. So he turned it and he himself did not react. He called the emergency who certifies that he had no vital signs. (emergency arrives within 5:45 am to 6:00 am)"
	"1105115-1"	"1105115-1"	"GROIN ABSCESS"	"10050269"	"18-29 years"	"18-29"	"Resident did not express having any symptoms, the only thing that the POC observed abscesses in the arm, groin, thigh and knees after the first vaccination. After the second dose, he was hypoactive. On 2/27 at about 3:30 am he asked him to turn on his side, between 4 am and 5 am POC went to the room I notice it strange, because his head was wrapped in the sheet. When the POC removed the sheet, she observed that her mouth and nose were full of secretions. So he turned it and he himself did not react. He called the emergency who certifies that he had no vital signs. (emergency arrives within 5:45 am to 6:00 am)"
	"1105115-1"	"1105115-1"	"INCREASED UPPER AIRWAY SECRETION"	"10062717"	"18-29 years"	"18-29"	"Resident did not express having any symptoms, the only thing that the POC observed abscesses in the arm, groin, thigh and knees after the first vaccination. After the second dose, he was hypoactive. On 2/27 at about 3:30 am he asked him to turn on his side, between 4 am and 5 am POC went to the room I notice it strange, because his head was wrapped in the sheet. When the POC removed the sheet, she observed that her mouth and nose were full of secretions. So he turned it and he himself did not react. He called the emergency who certifies that he had no vital signs. (emergency arrives within 5:45 am to 6:00 am)"
	"1105146-1"	"1105146-1"	"ASTHENIA"	"10003549"	"18-29 years"	"18-29"	"1/19 began vomiting and was hospitalized. On 1/30 he was discharged and later received the vaccine. It begins with weakness and a lack of appetite. He started coughing up foul-smelling secretions. He makes the arrangements to take him to the emergency room again, he called 911 to be transported, when they are taking the information from the POC, he is under oxygenation to 44. They take him in the ambulance, he receives CPR, they transport him to the facility where he arrives lifeless."
	"1105146-1"	"1105146-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"1/19 began vomiting and was hospitalized. On 1/30 he was discharged and later received the vaccine. It begins with weakness and a lack of appetite. He started coughing up foul-smelling secretions. He makes the arrangements to take him to the emergency room again, he called 911 to be transported, when they are taking the information from the POC, he is under oxygenation to 44. They take him in the ambulance, he receives CPR, they transport him to the facility where he arrives lifeless."
	"1105146-1"	"1105146-1"	"DECREASED APPETITE"	"10061428"	"18-29 years"	"18-29"	"1/19 began vomiting and was hospitalized. On 1/30 he was discharged and later received the vaccine. It begins with weakness and a lack of appetite. He started coughing up foul-smelling secretions. He makes the arrangements to take him to the emergency room again, he called 911 to be transported, when they are taking the information from the POC, he is under oxygenation to 44. They take him in the ambulance, he receives CPR, they transport him to the facility where he arrives lifeless."
	"1105146-1"	"1105146-1"	"PRODUCTIVE COUGH"	"10036790"	"18-29 years"	"18-29"	"1/19 began vomiting and was hospitalized. On 1/30 he was discharged and later received the vaccine. It begins with weakness and a lack of appetite. He started coughing up foul-smelling secretions. He makes the arrangements to take him to the emergency room again, he called 911 to be transported, when they are taking the information from the POC, he is under oxygenation to 44. They take him in the ambulance, he receives CPR, they transport him to the facility where he arrives lifeless."
	"1105146-1"	"1105146-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"1/19 began vomiting and was hospitalized. On 1/30 he was discharged and later received the vaccine. It begins with weakness and a lack of appetite. He started coughing up foul-smelling secretions. He makes the arrangements to take him to the emergency room again, he called 911 to be transported, when they are taking the information from the POC, he is under oxygenation to 44. They take him in the ambulance, he receives CPR, they transport him to the facility where he arrives lifeless."
	"1105146-1"	"1105146-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"1/19 began vomiting and was hospitalized. On 1/30 he was discharged and later received the vaccine. It begins with weakness and a lack of appetite. He started coughing up foul-smelling secretions. He makes the arrangements to take him to the emergency room again, he called 911 to be transported, when they are taking the information from the POC, he is under oxygenation to 44. They take him in the ambulance, he receives CPR, they transport him to the facility where he arrives lifeless."
	"1121695-1"	"1121695-1"	"ANALGESIC DRUG LEVEL"	"10060090"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"ANALGESIC DRUG LEVEL THERAPEUTIC"	"10060943"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"BLOOD BICARBONATE DECREASED"	"10005359"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"BLOOD KETONE BODY"	"10057593"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"BLOOD PH DECREASED"	"10005706"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"BRAIN DEATH"	"10049054"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"DIABETIC KETOACIDOSIS"	"10012671"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"DRUG SCREEN NEGATIVE"	"10050895"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"GLYCOSYLATED HAEMOGLOBIN"	"10018480"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"LIPASE INCREASED"	"10024574"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"MECHANICAL VENTILATION"	"10067221"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"METABOLIC ENCEPHALOPATHY"	"10062190"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"PCO2 DECREASED"	"10034181"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"PNEUMONIA ASPIRATION"	"10035669"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1121695-1"	"1121695-1"	"PO2 INCREASED"	"10035769"	"18-29 years"	"18-29"	"The patient, who has no significant past medical history including diabetes, presented with very severe diabetic ketoacidosis  one week after receiving the vaccine.  He  developed severe metabolic encephalopathy, aspiration pneumonia, and was placed on mechanical ventilation.  At the time of this reporting, he is brain death (awaiting apnea test confirmation).  He is expected not to survive."
	"1129860-1"	"1129860-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Died January 21 after she received an mRNA shot; A spontaneous report was received from a consumer via social media concerning a 28-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and died two days later (death).   The patient's medical history was not provided.  No relevant concomitant medications were reported.   On 19 Jan 2021, per social media post, the patient received one of their two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection.   The reporter stated that the patient was dead on 21 Jan 2021.   Treatment information was not provided.    Action taken with mRNA-1273 in response to the event was not applicable.  The patient died on 21 Jan 2021. The cause of death was reported as unknown.  An autopsy was done.  The reporter stated that the autopsy showed no other red flags, otherwise, no additional autopsy results were reported.; Reporter's Comments: Very limited information regarding this event has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death"
	"1140258-1"	"1140258-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Patient contacted 911 complaining of not feeling well and difficulty breathing. Upon arrival patient was found by EMS in cardiac arrest. EMS was unable to get return of spontaneous circulation."
	"1140258-1"	"1140258-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Patient contacted 911 complaining of not feeling well and difficulty breathing. Upon arrival patient was found by EMS in cardiac arrest. EMS was unable to get return of spontaneous circulation."
	"1140258-1"	"1140258-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"Patient contacted 911 complaining of not feeling well and difficulty breathing. Upon arrival patient was found by EMS in cardiac arrest. EMS was unable to get return of spontaneous circulation."
	"1145918-1"	"1145918-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	""As reported by the patient's mother, the  patient received the vaccine on 1/19/21, ""got sick"" on 1/20/21, and died in the early morning hours of 1/21/21. No further information was offered.""
	"1145918-1"	"1145918-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	""As reported by the patient's mother, the  patient received the vaccine on 1/19/21, ""got sick"" on 1/20/21, and died in the early morning hours of 1/21/21. No further information was offered.""
	"1159535-1"	"1159535-1"	"AMYLASE"	"10002013"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"ANALGESIC DRUG LEVEL"	"10060090"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"BLOOD CREATINE PHOSPHOKINASE"	"10005467"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"BLOOD GASES"	"10005537"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"BLOOD LACTIC ACID"	"10005632"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"CHEST X-RAY"	"10008498"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"COAGULATION TEST ABNORMAL"	"10063557"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"COMPUTERISED TOMOGRAM ABDOMEN"	"10053876"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"COMPUTERISED TOMOGRAM HEAD"	"10054003"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"COMPUTERISED TOMOGRAM THORAX"	"10053875"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"CYANOSIS"	"10011703"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"ELECTROCARDIOGRAM"	"10014362"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"FULL BLOOD COUNT"	"10017411"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"HEPATIC ENZYME INCREASED"	"10060795"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"HEPATIC FAILURE"	"10019663"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"HYPOTENSION"	"10021097"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"HYPOXIA"	"10021143"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"LEUKOCYTOSIS"	"10024378"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"LIPASE"	"10050659"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"METABOLIC ACIDOSIS"	"10027417"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"METABOLIC FUNCTION TEST"	"10062191"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"MYALGIA"	"10028411"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"RENAL FAILURE"	"10038435"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"TROPONIN"	"10061576"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1159535-1"	"1159535-1"	"URINE ANALYSIS"	"10046614"	"18-29 years"	"18-29"	"Patient described myalgias, headache and dyspnea at ER visit on 4/1/21 at 2:37 am. Patient was discharged. Patient returned the same day at 15:40 cyanotic, altered, hypoxic and hypotensive. The patient was found to have profound metabolic acidosis, liver failure, renal failure. She went into cardiopulmonary arrest, was revived, rearrested and died. Patient was treated for possible sepsis, shock, liver failure."
	"1166062-1"	"1166062-1"	"DEATH"	"10011906"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1166062-1"	"1166062-1"	"DIET REFUSAL"	"10012775"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1166062-1"	"1166062-1"	"EMOTIONAL DISTRESS"	"10049119"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1166062-1"	"1166062-1"	"EXPOSURE VIA BREAST MILK"	"10080751"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1166062-1"	"1166062-1"	"FAILURE TO THRIVE"	"10016165"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1166062-1"	"1166062-1"	"HEPATIC ENZYME INCREASED"	"10060795"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1166062-1"	"1166062-1"	"PYREXIA"	"10037660"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1166062-1"	"1166062-1"	"RASH"	"10037844"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1166062-1"	"1166062-1"	"THROMBOTIC THROMBOCYTOPENIC PURPURA"	"10043648"	"< 6 months"	"0"	"Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother's vaccination the previous day."
	"1168641-1"	"1168641-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death."
	"1177058-1"	"1177058-1"	"ANAPHYLACTIC REACTION"	"10002198"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"ASPIRIN-EXACERBATED RESPIRATORY DISEASE"	"10075084"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"BRAIN DEATH"	"10049054"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"BRAIN HERNIATION"	"10006126"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"CONDITION AGGRAVATED"	"10010264"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"DIARRHOEA"	"10012735"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"GASTROINTESTINAL DISORDER"	"10017944"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"INTENSIVE CARE"	"10022519"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1177058-1"	"1177058-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	""Family reports that patient had her 2nd dose of COVID-19 vaccine on 4/1, approximately 3 weeks after her first dose.  Patient had one week history of ""allergy type"" symptoms.  Evening of 4/1 developed ""GI symptoms and diarrhea"".  Morning of 4/2 her ""neighbor came by to check on her and she stated that she was not feeling very well last night but thought she just needed some Gatorade of something...He stated that as he gave her the alka-Seltzer he told her that there was aspirin in it which apparently she has an allergy to.  He stated that her response was I should be fine I do not think I'm that allergic to aspirin...5 to 10 minutes later she started to have some issues...Patient stated to her neighbor that she was having a hard time breathing and thought she needed to go to the hospital, and that maybe she was more allergic to the aspirin than she had thought...Over the 15 miles between her house and the hospital patient condition deteriorated to the point where they arrived at the hospital she is in full cardiac arrest...given ACLS protocol including epinephrine and was intubated.""  ""They achieved ROSC after approximately 10 minutes.""  Patient was then flown, MT emergency department to Hospital.  Patient was cared for in the ICU.  Patient herniated her brain the night of 4/5-4/6.  ""After meeting the clinical and imaging criteria at 1605 on 4/6/2021 she was declared brain dead.  Medical team suggests that patient had Samter's Triad/Triad Asthma with history of asthma, nasal polyps and allergy to aspirin.  Anaphylaxis secondary to ingestion of aspirin via Alka-Seltzer.""
	"1198540-1"	"1198540-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Unknown if the vaccine has any correlation to event. Patient was found unresponsive and not breathing on 4/11/21 @ approximately 3:45 PM outside on the grounds of the campus. A rented scoter was next to him. There was no sign of trauma. 9-1-1 was called and CPR initiated by passerby (there were no witnesses). He remained unresponsive and was intubated when the paramedics arrived. He was transported to hospital where he was pronounced dead."
	"1198540-1"	"1198540-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"Unknown if the vaccine has any correlation to event. Patient was found unresponsive and not breathing on 4/11/21 @ approximately 3:45 PM outside on the grounds of the campus. A rented scoter was next to him. There was no sign of trauma. 9-1-1 was called and CPR initiated by passerby (there were no witnesses). He remained unresponsive and was intubated when the paramedics arrived. He was transported to hospital where he was pronounced dead."
	"1198540-1"	"1198540-1"	"RESPIRATORY ARREST"	"10038669"	"18-29 years"	"18-29"	"Unknown if the vaccine has any correlation to event. Patient was found unresponsive and not breathing on 4/11/21 @ approximately 3:45 PM outside on the grounds of the campus. A rented scoter was next to him. There was no sign of trauma. 9-1-1 was called and CPR initiated by passerby (there were no witnesses). He remained unresponsive and was intubated when the paramedics arrived. He was transported to hospital where he was pronounced dead."
	"1198540-1"	"1198540-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"Unknown if the vaccine has any correlation to event. Patient was found unresponsive and not breathing on 4/11/21 @ approximately 3:45 PM outside on the grounds of the campus. A rented scoter was next to him. There was no sign of trauma. 9-1-1 was called and CPR initiated by passerby (there were no witnesses). He remained unresponsive and was intubated when the paramedics arrived. He was transported to hospital where he was pronounced dead."
	"1198540-1"	"1198540-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"18-29 years"	"18-29"	"Unknown if the vaccine has any correlation to event. Patient was found unresponsive and not breathing on 4/11/21 @ approximately 3:45 PM outside on the grounds of the campus. A rented scoter was next to him. There was no sign of trauma. 9-1-1 was called and CPR initiated by passerby (there were no witnesses). He remained unresponsive and was intubated when the paramedics arrived. He was transported to hospital where he was pronounced dead."
	"1199455-1"	"1199455-1"	"CARDIAC ARREST"	"10007515"	"6-17 years"	"6-17"	"Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death"
	"1199455-1"	"1199455-1"	"CHEST PAIN"	"10008479"	"6-17 years"	"6-17"	"Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death"
	"1199455-1"	"1199455-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death"
	"1199455-1"	"1199455-1"	"DYSPNOEA"	"10013968"	"6-17 years"	"6-17"	"Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death"
	"1204016-1"	"1204016-1"	"SUDDEN DEATH"	"10042434"	"18-29 years"	"18-29"	"HE  DIED  SUDDENLY !!!!! JUST  COLLAPSED  !!!!"
	"1204016-1"	"1204016-1"	"SYNCOPE"	"10042772"	"18-29 years"	"18-29"	"HE  DIED  SUDDENLY !!!!! JUST  COLLAPSED  !!!!"
	"1206330-1"	"1206330-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Death"
	"1206330-1"	"1206330-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death"
	"1209903-1"	"1209903-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"I DON'T KNOW THE EXACT EVENTS FOR THE CASE, BUT WAS ASKED TO FILL IN THE INFORMATION THE BEST I COULD WITH THE INFORMATION I HAD ON HAND. THIS YOUNG LADY, RECEIVED A COVID-19 VACCINE ON 3/6/2021 AND EXPIRED ON MARCH 13, 2021. THIS IS MOST OF THE INFORMATION THAT I HAVE. YOU WOULD NEED TO CONTACT THE MEDICAL EXAMINER'S OFFICE, THAT WILL BE ABEL TO PROVIDE YOU WITH MOST DETAIL FOR THIS CASE."
	"1224177-1"	"1224177-1"	"CEREBROVASCULAR DISORDER"	"10008196"	"18-29 years"	"18-29"	"Blood clot blocking blood flow to brain -  1st episode: ( 3/12/21) stabilized, minor limited movement left side -  2nd episode: (3/24/21) no blood flow to brain, death (maintained on life support for organ donation)"
	"1224177-1"	"1224177-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Blood clot blocking blood flow to brain -  1st episode: ( 3/12/21) stabilized, minor limited movement left side -  2nd episode: (3/24/21) no blood flow to brain, death (maintained on life support for organ donation)"
	"1224177-1"	"1224177-1"	"LIFE SUPPORT"	"10024447"	"18-29 years"	"18-29"	"Blood clot blocking blood flow to brain -  1st episode: ( 3/12/21) stabilized, minor limited movement left side -  2nd episode: (3/24/21) no blood flow to brain, death (maintained on life support for organ donation)"
	"1224177-1"	"1224177-1"	"MOBILITY DECREASED"	"10048334"	"18-29 years"	"18-29"	"Blood clot blocking blood flow to brain -  1st episode: ( 3/12/21) stabilized, minor limited movement left side -  2nd episode: (3/24/21) no blood flow to brain, death (maintained on life support for organ donation)"
	"1224177-1"	"1224177-1"	"THROMBOSIS"	"10043607"	"18-29 years"	"18-29"	"Blood clot blocking blood flow to brain -  1st episode: ( 3/12/21) stabilized, minor limited movement left side -  2nd episode: (3/24/21) no blood flow to brain, death (maintained on life support for organ donation)"
	"1225942-1"	"1225942-1"	"CARDIAC ARREST"	"10007515"	"6-17 years"	"6-17"	"Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use.  Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21."
	"1225942-1"	"1225942-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use.  Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21."
	"1225942-1"	"1225942-1"	"LABORATORY TEST"	"10059938"	"6-17 years"	"6-17"	"Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use.  Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21."
	"1225942-1"	"1225942-1"	"LUNG ASSIST DEVICE THERAPY"	"10082527"	"6-17 years"	"6-17"	"Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use.  Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21."
	"1225942-1"	"1225942-1"	"ORAL CONTRACEPTION"	"10030970"	"6-17 years"	"6-17"	"Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use.  Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21."
	"1225942-1"	"1225942-1"	"PULMONARY EMBOLISM"	"10037377"	"6-17 years"	"6-17"	"Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use.  Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21."
	"1225942-1"	"1225942-1"	"RESUSCITATION"	"10038749"	"6-17 years"	"6-17"	"Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use.  Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21."
	"1237709-1"	"1237709-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient deceased"
	"1242573-1"	"1242573-1"	"CARDIAC FAILURE"	"10007554"	"6-17 years"	"6-17"	"Heart failure"
	"1242573-1"	"1242573-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Heart failure"
	"1243487-1"	"1243487-1"	"COMPLETED SUICIDE"	"10010144"	"6-17 years"	"6-17"	"Patient Committed Suicide with a firearm."
	"1243791-1"	"1243791-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Per the father, the deceased received his first shot of Moderna vaccine on Saturday, 4/10/2021 at a local church. He did not work on 4/11/2021. Worked on 4/12/2021. The deceased was found dead at 6:43 p.m. at his home."
	"1243832-1"	"1243832-1"	"ATRIOVENTRICULAR BLOCK"	"10003671"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"BODY TEMPERATURE INCREASED"	"10005911"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"CHILLS"	"10008531"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"CONDITION AGGRAVATED"	"10010264"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"ELECTROLYTE IMBALANCE"	"10014418"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"FALL"	"10016173"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"FATIGUE"	"10016256"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"FEELING ABNORMAL"	"10016322"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"PAIN IN EXTREMITY"	"10033425"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"PYREXIA"	"10037660"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"RESPIRATORY ARREST"	"10038669"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1243832-1"	"1243832-1"	"RHINORRHOEA"	"10039101"	"18-29 years"	"18-29"	""4.21.2021- I spoke with (patient's husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021-  Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband ""my arm really hurts."" She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated ""she was never the same after the vaccination.""""
	"1247997-1"	"1247997-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Per his parents, patient started feeling nauseous an hour or two after the vaccine and at night around 10pm it worsened where he felt nauseous, had shivers and he vomited in the middle of the night. He then vomited again the next day and continued to not feel well the next couple of days. On 4/20/2021 at around 4:20pm he called his mother, his girlfriend and his mentor that he was not feeling well, was nauseous and dizzy and had shivers and was going to pull over on his car to get something to drink. He then stopped answering his phone and was found dead in his car later on that day. Police is investigating the case."
	"1247997-1"	"1247997-1"	"CHILLS"	"10008531"	"18-29 years"	"18-29"	"Per his parents, patient started feeling nauseous an hour or two after the vaccine and at night around 10pm it worsened where he felt nauseous, had shivers and he vomited in the middle of the night. He then vomited again the next day and continued to not feel well the next couple of days. On 4/20/2021 at around 4:20pm he called his mother, his girlfriend and his mentor that he was not feeling well, was nauseous and dizzy and had shivers and was going to pull over on his car to get something to drink. He then stopped answering his phone and was found dead in his car later on that day. Police is investigating the case."
	"1247997-1"	"1247997-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Per his parents, patient started feeling nauseous an hour or two after the vaccine and at night around 10pm it worsened where he felt nauseous, had shivers and he vomited in the middle of the night. He then vomited again the next day and continued to not feel well the next couple of days. On 4/20/2021 at around 4:20pm he called his mother, his girlfriend and his mentor that he was not feeling well, was nauseous and dizzy and had shivers and was going to pull over on his car to get something to drink. He then stopped answering his phone and was found dead in his car later on that day. Police is investigating the case."
	"1247997-1"	"1247997-1"	"DIZZINESS"	"10013573"	"18-29 years"	"18-29"	"Per his parents, patient started feeling nauseous an hour or two after the vaccine and at night around 10pm it worsened where he felt nauseous, had shivers and he vomited in the middle of the night. He then vomited again the next day and continued to not feel well the next couple of days. On 4/20/2021 at around 4:20pm he called his mother, his girlfriend and his mentor that he was not feeling well, was nauseous and dizzy and had shivers and was going to pull over on his car to get something to drink. He then stopped answering his phone and was found dead in his car later on that day. Police is investigating the case."
	"1247997-1"	"1247997-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"Per his parents, patient started feeling nauseous an hour or two after the vaccine and at night around 10pm it worsened where he felt nauseous, had shivers and he vomited in the middle of the night. He then vomited again the next day and continued to not feel well the next couple of days. On 4/20/2021 at around 4:20pm he called his mother, his girlfriend and his mentor that he was not feeling well, was nauseous and dizzy and had shivers and was going to pull over on his car to get something to drink. He then stopped answering his phone and was found dead in his car later on that day. Police is investigating the case."
	"1247997-1"	"1247997-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"Per his parents, patient started feeling nauseous an hour or two after the vaccine and at night around 10pm it worsened where he felt nauseous, had shivers and he vomited in the middle of the night. He then vomited again the next day and continued to not feel well the next couple of days. On 4/20/2021 at around 4:20pm he called his mother, his girlfriend and his mentor that he was not feeling well, was nauseous and dizzy and had shivers and was going to pull over on his car to get something to drink. He then stopped answering his phone and was found dead in his car later on that day. Police is investigating the case."
	"1247997-1"	"1247997-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Per his parents, patient started feeling nauseous an hour or two after the vaccine and at night around 10pm it worsened where he felt nauseous, had shivers and he vomited in the middle of the night. He then vomited again the next day and continued to not feel well the next couple of days. On 4/20/2021 at around 4:20pm he called his mother, his girlfriend and his mentor that he was not feeling well, was nauseous and dizzy and had shivers and was going to pull over on his car to get something to drink. He then stopped answering his phone and was found dead in his car later on that day. Police is investigating the case."
	"1258614-1"	"1258614-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Patient presented to ED for 2 syncopal episodes and went into cardiac arrest 5 minutes prior to ED arrival in ambulance. She received ACLS measures and alteplase was mixed and administered for pulmonary embolism concern."
	"1258614-1"	"1258614-1"	"LIFE SUPPORT"	"10024447"	"18-29 years"	"18-29"	"Patient presented to ED for 2 syncopal episodes and went into cardiac arrest 5 minutes prior to ED arrival in ambulance. She received ACLS measures and alteplase was mixed and administered for pulmonary embolism concern."
	"1258614-1"	"1258614-1"	"SYNCOPE"	"10042772"	"18-29 years"	"18-29"	"Patient presented to ED for 2 syncopal episodes and went into cardiac arrest 5 minutes prior to ED arrival in ambulance. She received ACLS measures and alteplase was mixed and administered for pulmonary embolism concern."
	"1261766-1"	"1261766-1"	"BODY TEMPERATURE INCREASED"	"10005911"	"1-2 years"	"1-2"	"increased body temperature, seizure, death"
	"1261766-1"	"1261766-1"	"DEATH"	"10011906"	"1-2 years"	"1-2"	"increased body temperature, seizure, death"
	"1261766-1"	"1261766-1"	"SEIZURE"	"10039906"	"1-2 years"	"1-2"	"increased body temperature, seizure, death"
	"1273475-1"	"1273475-1"	"APNOEA"	"10002974"	"18-29 years"	"18-29"	"on 04/29/2021 Resident was checked at 1830 and found to be at baseline status.  At approximately 1855, resident was found pulses and apneic.  CPR initiated and resident transferred to medical center. Resident expired 1939."
	"1273475-1"	"1273475-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"on 04/29/2021 Resident was checked at 1830 and found to be at baseline status.  At approximately 1855, resident was found pulses and apneic.  CPR initiated and resident transferred to medical center. Resident expired 1939."
	"1273475-1"	"1273475-1"	"PULSE ABSENT"	"10037469"	"18-29 years"	"18-29"	"on 04/29/2021 Resident was checked at 1830 and found to be at baseline status.  At approximately 1855, resident was found pulses and apneic.  CPR initiated and resident transferred to medical center. Resident expired 1939."
	"1273475-1"	"1273475-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"on 04/29/2021 Resident was checked at 1830 and found to be at baseline status.  At approximately 1855, resident was found pulses and apneic.  CPR initiated and resident transferred to medical center. Resident expired 1939."
	"1278030-1"	"1278030-1"	"ALANINE AMINOTRANSFERASE INCREASED"	"10001551"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"ASPARTATE AMINOTRANSFERASE INCREASED"	"10003481"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"BLOOD CREATINE PHOSPHOKINASE INCREASED"	"10005470"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"BLOOD LACTIC ACID"	"10005632"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"BLOOD PARATHYROID HORMONE INCREASED"	"10005703"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"BLOOD PH INCREASED"	"10005708"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"CARDIAC FAILURE"	"10007554"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"CATHETERISATION CARDIAC NORMAL"	"10007817"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"EJECTION FRACTION NORMAL"	"10064144"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"ELECTROCARDIOGRAM ST SEGMENT ELEVATION"	"10014392"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"FEELING ABNORMAL"	"10016322"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"FIBRIN D DIMER NORMAL"	"10016583"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"HAEMODYNAMIC INSTABILITY"	"10052076"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"IMMUNOGLOBULIN THERAPY"	"10069534"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"LIFE SUPPORT"	"10024447"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"LUNG ASSIST DEVICE THERAPY"	"10082527"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"PERICARDIAL EFFUSION"	"10034474"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"PULSE ABSENT"	"10037469"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"SERUM FERRITIN INCREASED"	"10040250"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"THERAPEUTIC HYPOTHERMIA"	"10059485"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"TROPONIN"	"10061576"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1278030-1"	"1278030-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	""27 year old male with Down's Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began ""feeling poorly"" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.""
	"1286275-1"	"1286275-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death due to a Subarachnoid hemorrhage"
	"1286275-1"	"1286275-1"	"SUBARACHNOID HAEMORRHAGE"	"10042316"	"18-29 years"	"18-29"	"Death due to a Subarachnoid hemorrhage"
	"1302844-1"	"1302844-1"	"ABDOMINAL PAIN"	"10000081"	"18-29 years"	"18-29"	"Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day.  Decedent was found deceased the next evening."
	"1302844-1"	"1302844-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day.  Decedent was found deceased the next evening."
	"1302844-1"	"1302844-1"	"CHEST PAIN"	"10008479"	"18-29 years"	"18-29"	"Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day.  Decedent was found deceased the next evening."
	"1302844-1"	"1302844-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day.  Decedent was found deceased the next evening."
	"1302844-1"	"1302844-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day.  Decedent was found deceased the next evening."
	"1302844-1"	"1302844-1"	"LETHARGY"	"10024264"	"18-29 years"	"18-29"	"Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day.  Decedent was found deceased the next evening."
	"1307657-1"	"1307657-1"	"COMPLETED SUICIDE"	"10010144"	"6-17 years"	"6-17"	"Death by suicide."
	"1321517-1"	"1321517-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"He did not told me about any symptoms. He just died the next day of the vaccine. Still today doesn?t know why he died. He appeared to be in good health."
	"1334527-1"	"1334527-1"	"ABNORMAL BEHAVIOUR"	"10061422"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"BLOOD POTASSIUM DECREASED"	"10005724"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"BLOOD TEST ABNORMAL"	"10061016"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"COUGH"	"10011224"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"ECHOCARDIOGRAM"	"10014113"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"HAEMOPTYSIS"	"10018964"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"HEART RATE INCREASED"	"10019303"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"INFECTION"	"10021789"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"MOBILITY DECREASED"	"10048334"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"PALLOR"	"10033546"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"PULMONARY OEDEMA"	"10037423"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1334527-1"	"1334527-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"18-29 years"	"18-29"	"My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much.  On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema.  It escalated so quickly."
	"1343614-1"	"1343614-1"	"ASTHENIA"	"10003549"	"18-29 years"	"18-29"	"presented to ED dept confused, incr n/v, weakness. Received palliative carex4 days. deceased 05/24"
	"1343614-1"	"1343614-1"	"CONFUSIONAL STATE"	"10010305"	"18-29 years"	"18-29"	"presented to ED dept confused, incr n/v, weakness. Received palliative carex4 days. deceased 05/24"
	"1343614-1"	"1343614-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"presented to ED dept confused, incr n/v, weakness. Received palliative carex4 days. deceased 05/24"
	"1343614-1"	"1343614-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"presented to ED dept confused, incr n/v, weakness. Received palliative carex4 days. deceased 05/24"
	"1343614-1"	"1343614-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"presented to ED dept confused, incr n/v, weakness. Received palliative carex4 days. deceased 05/24"
	"1346657-1"	"1346657-1"	"ARRHYTHMIA"	"10003119"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1346657-1"	"1346657-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1346657-1"	"1346657-1"	"BLOOD IMMUNOGLOBULIN E INCREASED"	"10005591"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1346657-1"	"1346657-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1346657-1"	"1346657-1"	"HISTOLOGY"	"10062005"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1346657-1"	"1346657-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1346657-1"	"1346657-1"	"SEIZURE"	"10039906"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1346657-1"	"1346657-1"	"TOXICOLOGIC TEST"	"10061384"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1346657-1"	"1346657-1"	"TRYPTASE"	"10063240"	"18-29 years"	"18-29"	"Found deceased in bed, no known symptoms, undetermined cause and manner of death"
	"1347105-1"	"1347105-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Found dead on May 3, 2021. Question day of death 05/01/2021.  Medical examiners case. Cause pending, possible SUDEP."
	"1347547-1"	"1347547-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"The injury that led to the death occurred within 1 day of the decedent receiving the vaccine"
	"1347547-1"	"1347547-1"	"INJURY"	"10022116"	"18-29 years"	"18-29"	"The injury that led to the death occurred within 1 day of the decedent receiving the vaccine"
	"1349127-1"	"1349127-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"found dead; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (found dead) in a 22-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032m20a) for COVID-19 vaccination.     Concurrent medical conditions included Traumatic brain injury, Movement disorder, Seizures (since she was a baby at 11 months old) and Speech loss. Concomitant products included CLONAZEPAM, OXCARBAZEPINE (TRILEPTAL) and GABAPENTIN for an unknown indication.    On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 04-Apr-2021 The patient died on 04-Apr-2021. The cause of death was not reported. An autopsy was not performed.            Reporter stated that death certificate said the cause of death was natural causes. She did have her yearly physical exam after her first dose with her physician prior to her death and no other health issues were noted at the time of the exam.  Very limited information regarding this event has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this event has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: Natural causes"
	"1355039-1"	"1355039-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Cardiac Arrest"
	"1365007-1"	"1365007-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"I do not know the individuals medical hx or illness/complications. Due to new information circulating related to mRNA vaccines and myocarditis/pericarditis and being made aware that this person had suffered cardiac arrest after being admit to the hospital following complications with their health it warrants being reported regardless of prior health conditions."
	"1365075-1"	"1365075-1"	"COMPUTERISED TOMOGRAM HEAD"	"10054003"	"18-29 years"	"18-29"	"Patients father said his son began throwing up 2 days after injection. They  took him to the ER and patient was given some medication to stop emesis. Two days later patient was still throwing up and the ER told him to give the medication a couple more days to work. The father said the throwing up was not constant and patient was able to eat and keep it down. The emesis was reported as dark brown mucous   with no food particles in it. Patient was reported to throw up everyday until his death on day 9."
	"1365075-1"	"1365075-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patients father said his son began throwing up 2 days after injection. They  took him to the ER and patient was given some medication to stop emesis. Two days later patient was still throwing up and the ER told him to give the medication a couple more days to work. The father said the throwing up was not constant and patient was able to eat and keep it down. The emesis was reported as dark brown mucous   with no food particles in it. Patient was reported to throw up everyday until his death on day 9."
	"1365075-1"	"1365075-1"	"DISCOLOURED VOMIT"	"10079120"	"18-29 years"	"18-29"	"Patients father said his son began throwing up 2 days after injection. They  took him to the ER and patient was given some medication to stop emesis. Two days later patient was still throwing up and the ER told him to give the medication a couple more days to work. The father said the throwing up was not constant and patient was able to eat and keep it down. The emesis was reported as dark brown mucous   with no food particles in it. Patient was reported to throw up everyday until his death on day 9."
	"1365075-1"	"1365075-1"	"LABORATORY TEST"	"10059938"	"18-29 years"	"18-29"	"Patients father said his son began throwing up 2 days after injection. They  took him to the ER and patient was given some medication to stop emesis. Two days later patient was still throwing up and the ER told him to give the medication a couple more days to work. The father said the throwing up was not constant and patient was able to eat and keep it down. The emesis was reported as dark brown mucous   with no food particles in it. Patient was reported to throw up everyday until his death on day 9."
	"1366320-1"	"1366320-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"He died"
	"1368779-1"	"1368779-1"	"ABDOMINAL DISTENSION"	"10000060"	"18-29 years"	"18-29"	""After receiving second dose of vaccine, complained of stomach pain and feeling ""bloated."" Later had muscle pain, insomnia, and nausea.  Found dead at home on 6/1.""
	"1368779-1"	"1368779-1"	"ABDOMINAL PAIN UPPER"	"10000087"	"18-29 years"	"18-29"	""After receiving second dose of vaccine, complained of stomach pain and feeling ""bloated."" Later had muscle pain, insomnia, and nausea.  Found dead at home on 6/1.""
	"1368779-1"	"1368779-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	""After receiving second dose of vaccine, complained of stomach pain and feeling ""bloated."" Later had muscle pain, insomnia, and nausea.  Found dead at home on 6/1.""
	"1368779-1"	"1368779-1"	"INSOMNIA"	"10022437"	"18-29 years"	"18-29"	""After receiving second dose of vaccine, complained of stomach pain and feeling ""bloated."" Later had muscle pain, insomnia, and nausea.  Found dead at home on 6/1.""
	"1368779-1"	"1368779-1"	"MYALGIA"	"10028411"	"18-29 years"	"18-29"	""After receiving second dose of vaccine, complained of stomach pain and feeling ""bloated."" Later had muscle pain, insomnia, and nausea.  Found dead at home on 6/1.""
	"1368779-1"	"1368779-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	""After receiving second dose of vaccine, complained of stomach pain and feeling ""bloated."" Later had muscle pain, insomnia, and nausea.  Found dead at home on 6/1.""
	"1369287-1"	"1369287-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1369287-1"	"1369287-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1369287-1"	"1369287-1"	"CHEST PAIN"	"10008479"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1369287-1"	"1369287-1"	"CHILLS"	"10008531"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1369287-1"	"1369287-1"	"FATIGUE"	"10016256"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1369287-1"	"1369287-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1369287-1"	"1369287-1"	"SUDDEN CARDIAC DEATH"	"10049418"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1369287-1"	"1369287-1"	"TOXICOLOGIC TEST NORMAL"	"10061383"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1369287-1"	"1369287-1"	"VACCINATION COMPLICATION"	"10046861"	"18-29 years"	"18-29"	"Sudden cardiac death.  After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2."
	"1372120-1"	"1372120-1"	"APNOEIC ATTACK"	"10002977"	"18-29 years"	"18-29"	"Pt called 911 for shortness of breath The following is the paramedic narrative patient found at home, sitting on floor. alert, speaking. Patient with sob, saying she can not breath , states it came on suddenly about a half hour ago and pt has not been feeling ill prior to this. No trauma, no pains or other complaints.  pt went unconscious then into pea cardiac arrest, witnessed. Laid pt down and check for heart beat and breathing, became pulseless and apneic Initial treatment CPR, IV, BVM. Family states no medical history other than anemia.  no drug use, no respiratory or cardiac issues.  Pt was given J and J covid 19 vaccine recently.  Pt also just returned from a trip and noted to not have gone diving.    2 epinephrine IV given on scene with no change to heart rhythm.  Pt loaded into the ambulance and cpr continued while transporting.  pt with copious amounts of vomit, suction enroute to ed.  Pt w/o shockable rhythm throughout transport.  Continue cpr and bvm via king airway , cap at 9. unable to get capnography higher.  no change in heart rhythm. while enroute to er.  At ED pt did get pulses back however it was reported that pt loss pulses and was pronounced"
	"1372120-1"	"1372120-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Pt called 911 for shortness of breath The following is the paramedic narrative patient found at home, sitting on floor. alert, speaking. Patient with sob, saying she can not breath , states it came on suddenly about a half hour ago and pt has not been feeling ill prior to this. No trauma, no pains or other complaints.  pt went unconscious then into pea cardiac arrest, witnessed. Laid pt down and check for heart beat and breathing, became pulseless and apneic Initial treatment CPR, IV, BVM. Family states no medical history other than anemia.  no drug use, no respiratory or cardiac issues.  Pt was given J and J covid 19 vaccine recently.  Pt also just returned from a trip and noted to not have gone diving.    2 epinephrine IV given on scene with no change to heart rhythm.  Pt loaded into the ambulance and cpr continued while transporting.  pt with copious amounts of vomit, suction enroute to ed.  Pt w/o shockable rhythm throughout transport.  Continue cpr and bvm via king airway , cap at 9. unable to get capnography higher.  no change in heart rhythm. while enroute to er.  At ED pt did get pulses back however it was reported that pt loss pulses and was pronounced"
	"1372120-1"	"1372120-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Pt called 911 for shortness of breath The following is the paramedic narrative patient found at home, sitting on floor. alert, speaking. Patient with sob, saying she can not breath , states it came on suddenly about a half hour ago and pt has not been feeling ill prior to this. No trauma, no pains or other complaints.  pt went unconscious then into pea cardiac arrest, witnessed. Laid pt down and check for heart beat and breathing, became pulseless and apneic Initial treatment CPR, IV, BVM. Family states no medical history other than anemia.  no drug use, no respiratory or cardiac issues.  Pt was given J and J covid 19 vaccine recently.  Pt also just returned from a trip and noted to not have gone diving.    2 epinephrine IV given on scene with no change to heart rhythm.  Pt loaded into the ambulance and cpr continued while transporting.  pt with copious amounts of vomit, suction enroute to ed.  Pt w/o shockable rhythm throughout transport.  Continue cpr and bvm via king airway , cap at 9. unable to get capnography higher.  no change in heart rhythm. while enroute to er.  At ED pt did get pulses back however it was reported that pt loss pulses and was pronounced"
	"1372120-1"	"1372120-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"18-29 years"	"18-29"	"Pt called 911 for shortness of breath The following is the paramedic narrative patient found at home, sitting on floor. alert, speaking. Patient with sob, saying she can not breath , states it came on suddenly about a half hour ago and pt has not been feeling ill prior to this. No trauma, no pains or other complaints.  pt went unconscious then into pea cardiac arrest, witnessed. Laid pt down and check for heart beat and breathing, became pulseless and apneic Initial treatment CPR, IV, BVM. Family states no medical history other than anemia.  no drug use, no respiratory or cardiac issues.  Pt was given J and J covid 19 vaccine recently.  Pt also just returned from a trip and noted to not have gone diving.    2 epinephrine IV given on scene with no change to heart rhythm.  Pt loaded into the ambulance and cpr continued while transporting.  pt with copious amounts of vomit, suction enroute to ed.  Pt w/o shockable rhythm throughout transport.  Continue cpr and bvm via king airway , cap at 9. unable to get capnography higher.  no change in heart rhythm. while enroute to er.  At ED pt did get pulses back however it was reported that pt loss pulses and was pronounced"
	"1372120-1"	"1372120-1"	"PULSE ABSENT"	"10037469"	"18-29 years"	"18-29"	"Pt called 911 for shortness of breath The following is the paramedic narrative patient found at home, sitting on floor. alert, speaking. Patient with sob, saying she can not breath , states it came on suddenly about a half hour ago and pt has not been feeling ill prior to this. No trauma, no pains or other complaints.  pt went unconscious then into pea cardiac arrest, witnessed. Laid pt down and check for heart beat and breathing, became pulseless and apneic Initial treatment CPR, IV, BVM. Family states no medical history other than anemia.  no drug use, no respiratory or cardiac issues.  Pt was given J and J covid 19 vaccine recently.  Pt also just returned from a trip and noted to not have gone diving.    2 epinephrine IV given on scene with no change to heart rhythm.  Pt loaded into the ambulance and cpr continued while transporting.  pt with copious amounts of vomit, suction enroute to ed.  Pt w/o shockable rhythm throughout transport.  Continue cpr and bvm via king airway , cap at 9. unable to get capnography higher.  no change in heart rhythm. while enroute to er.  At ED pt did get pulses back however it was reported that pt loss pulses and was pronounced"
	"1372120-1"	"1372120-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"Pt called 911 for shortness of breath The following is the paramedic narrative patient found at home, sitting on floor. alert, speaking. Patient with sob, saying she can not breath , states it came on suddenly about a half hour ago and pt has not been feeling ill prior to this. No trauma, no pains or other complaints.  pt went unconscious then into pea cardiac arrest, witnessed. Laid pt down and check for heart beat and breathing, became pulseless and apneic Initial treatment CPR, IV, BVM. Family states no medical history other than anemia.  no drug use, no respiratory or cardiac issues.  Pt was given J and J covid 19 vaccine recently.  Pt also just returned from a trip and noted to not have gone diving.    2 epinephrine IV given on scene with no change to heart rhythm.  Pt loaded into the ambulance and cpr continued while transporting.  pt with copious amounts of vomit, suction enroute to ed.  Pt w/o shockable rhythm throughout transport.  Continue cpr and bvm via king airway , cap at 9. unable to get capnography higher.  no change in heart rhythm. while enroute to er.  At ED pt did get pulses back however it was reported that pt loss pulses and was pronounced"
	"1372120-1"	"1372120-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Pt called 911 for shortness of breath The following is the paramedic narrative patient found at home, sitting on floor. alert, speaking. Patient with sob, saying she can not breath , states it came on suddenly about a half hour ago and pt has not been feeling ill prior to this. No trauma, no pains or other complaints.  pt went unconscious then into pea cardiac arrest, witnessed. Laid pt down and check for heart beat and breathing, became pulseless and apneic Initial treatment CPR, IV, BVM. Family states no medical history other than anemia.  no drug use, no respiratory or cardiac issues.  Pt was given J and J covid 19 vaccine recently.  Pt also just returned from a trip and noted to not have gone diving.    2 epinephrine IV given on scene with no change to heart rhythm.  Pt loaded into the ambulance and cpr continued while transporting.  pt with copious amounts of vomit, suction enroute to ed.  Pt w/o shockable rhythm throughout transport.  Continue cpr and bvm via king airway , cap at 9. unable to get capnography higher.  no change in heart rhythm. while enroute to er.  At ED pt did get pulses back however it was reported that pt loss pulses and was pronounced"
	"1372338-1"	"1372338-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death"
	"1380716-1"	"1380716-1"	"ABDOMINAL DISCOMFORT"	"10000059"	"18-29 years"	"18-29"	"Missed second dose; Heart attack; heart was racing; stomach bothering him; 101.4 degrees fever; chills; some headaches; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 22-year-old male patient who received mRNA-1273 (batch no. 025B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     The patient's past medical history included Flu in February 2020. Concurrent medical conditions included Muscular dystrophy.    On 21-Apr-2021, the patient received first dose of mRNA-1273 (unknown route) 1 dosage form. On 01-May-2021, the patient experienced TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches). On 16-May-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed second dose). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 16-May-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (Missed second dose), TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches) outcome was unknown.            No Concomitant product use was provided  This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.   Most recent FOLLOW-UP information incorporated above includes: On 01-Jun-2021: Significant follow up received :- Patient died, Reporter email and phone number added, patient's medical history added,events updated; Sender's Comments: This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Heart Attack"
	"1380716-1"	"1380716-1"	"CHILLS"	"10008531"	"18-29 years"	"18-29"	"Missed second dose; Heart attack; heart was racing; stomach bothering him; 101.4 degrees fever; chills; some headaches; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 22-year-old male patient who received mRNA-1273 (batch no. 025B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     The patient's past medical history included Flu in February 2020. Concurrent medical conditions included Muscular dystrophy.    On 21-Apr-2021, the patient received first dose of mRNA-1273 (unknown route) 1 dosage form. On 01-May-2021, the patient experienced TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches). On 16-May-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed second dose). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 16-May-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (Missed second dose), TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches) outcome was unknown.            No Concomitant product use was provided  This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.   Most recent FOLLOW-UP information incorporated above includes: On 01-Jun-2021: Significant follow up received :- Patient died, Reporter email and phone number added, patient's medical history added,events updated; Sender's Comments: This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Heart Attack"
	"1380716-1"	"1380716-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Missed second dose; Heart attack; heart was racing; stomach bothering him; 101.4 degrees fever; chills; some headaches; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 22-year-old male patient who received mRNA-1273 (batch no. 025B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     The patient's past medical history included Flu in February 2020. Concurrent medical conditions included Muscular dystrophy.    On 21-Apr-2021, the patient received first dose of mRNA-1273 (unknown route) 1 dosage form. On 01-May-2021, the patient experienced TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches). On 16-May-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed second dose). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 16-May-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (Missed second dose), TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches) outcome was unknown.            No Concomitant product use was provided  This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.   Most recent FOLLOW-UP information incorporated above includes: On 01-Jun-2021: Significant follow up received :- Patient died, Reporter email and phone number added, patient's medical history added,events updated; Sender's Comments: This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Heart Attack"
	"1380716-1"	"1380716-1"	"MYOCARDIAL INFARCTION"	"10028596"	"18-29 years"	"18-29"	"Missed second dose; Heart attack; heart was racing; stomach bothering him; 101.4 degrees fever; chills; some headaches; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 22-year-old male patient who received mRNA-1273 (batch no. 025B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     The patient's past medical history included Flu in February 2020. Concurrent medical conditions included Muscular dystrophy.    On 21-Apr-2021, the patient received first dose of mRNA-1273 (unknown route) 1 dosage form. On 01-May-2021, the patient experienced TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches). On 16-May-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed second dose). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 16-May-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (Missed second dose), TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches) outcome was unknown.            No Concomitant product use was provided  This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.   Most recent FOLLOW-UP information incorporated above includes: On 01-Jun-2021: Significant follow up received :- Patient died, Reporter email and phone number added, patient's medical history added,events updated; Sender's Comments: This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Heart Attack"
	"1380716-1"	"1380716-1"	"PRODUCT DOSE OMISSION ISSUE"	"10084406"	"18-29 years"	"18-29"	"Missed second dose; Heart attack; heart was racing; stomach bothering him; 101.4 degrees fever; chills; some headaches; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 22-year-old male patient who received mRNA-1273 (batch no. 025B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     The patient's past medical history included Flu in February 2020. Concurrent medical conditions included Muscular dystrophy.    On 21-Apr-2021, the patient received first dose of mRNA-1273 (unknown route) 1 dosage form. On 01-May-2021, the patient experienced TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches). On 16-May-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed second dose). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 16-May-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (Missed second dose), TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches) outcome was unknown.            No Concomitant product use was provided  This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.   Most recent FOLLOW-UP information incorporated above includes: On 01-Jun-2021: Significant follow up received :- Patient died, Reporter email and phone number added, patient's medical history added,events updated; Sender's Comments: This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Heart Attack"
	"1380716-1"	"1380716-1"	"PYREXIA"	"10037660"	"18-29 years"	"18-29"	"Missed second dose; Heart attack; heart was racing; stomach bothering him; 101.4 degrees fever; chills; some headaches; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 22-year-old male patient who received mRNA-1273 (batch no. 025B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     The patient's past medical history included Flu in February 2020. Concurrent medical conditions included Muscular dystrophy.    On 21-Apr-2021, the patient received first dose of mRNA-1273 (unknown route) 1 dosage form. On 01-May-2021, the patient experienced TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches). On 16-May-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed second dose). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 16-May-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (Missed second dose), TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches) outcome was unknown.            No Concomitant product use was provided  This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.   Most recent FOLLOW-UP information incorporated above includes: On 01-Jun-2021: Significant follow up received :- Patient died, Reporter email and phone number added, patient's medical history added,events updated; Sender's Comments: This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Heart Attack"
	"1380716-1"	"1380716-1"	"TACHYCARDIA"	"10043071"	"18-29 years"	"18-29"	"Missed second dose; Heart attack; heart was racing; stomach bothering him; 101.4 degrees fever; chills; some headaches; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 22-year-old male patient who received mRNA-1273 (batch no. 025B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     The patient's past medical history included Flu in February 2020. Concurrent medical conditions included Muscular dystrophy.    On 21-Apr-2021, the patient received first dose of mRNA-1273 (unknown route) 1 dosage form. On 01-May-2021, the patient experienced TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches). On 16-May-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed second dose). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 16-May-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (Missed second dose), TACHYCARDIA (heart was racing), ABDOMINAL DISCOMFORT (stomach bothering him), PYREXIA (101.4 degrees fever), CHILLS (chills) and HEADACHE (some headaches) outcome was unknown.            No Concomitant product use was provided  This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.   Most recent FOLLOW-UP information incorporated above includes: On 01-Jun-2021: Significant follow up received :- Patient died, Reporter email and phone number added, patient's medical history added,events updated; Sender's Comments: This is a case of product dose omission issue. Very limited information regarding this patient's death has been provided at this time.  Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Heart Attack"
	"1382906-1"	"1382906-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Unexplained death within 48 hours"
	"1386054-1"	"1386054-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"DEATH FROM BLOOD CLOT"
	"1386054-1"	"1386054-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"DEATH FROM BLOOD CLOT"
	"1386054-1"	"1386054-1"	"THROMBOSIS"	"10043607"	"18-29 years"	"18-29"	"DEATH FROM BLOOD CLOT"
	"1386841-1"	"1386841-1"	"ABDOMINAL DISCOMFORT"	"10000059"	"6-17 years"	"6-17"	"Prodrome of headache and gastric upset over 2 days following second dose.  Then felt fine.  Found the following day dead in bed.  Autopsy pending"
	"1386841-1"	"1386841-1"	"CONDITION AGGRAVATED"	"10010264"	"6-17 years"	"6-17"	"Prodrome of headache and gastric upset over 2 days following second dose.  Then felt fine.  Found the following day dead in bed.  Autopsy pending"
	"1386841-1"	"1386841-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Prodrome of headache and gastric upset over 2 days following second dose.  Then felt fine.  Found the following day dead in bed.  Autopsy pending"
	"1386841-1"	"1386841-1"	"HEADACHE"	"10019211"	"6-17 years"	"6-17"	"Prodrome of headache and gastric upset over 2 days following second dose.  Then felt fine.  Found the following day dead in bed.  Autopsy pending"
	"1389518-1"	"1389518-1"	"INFLUENZA LIKE ILLNESS"	"10022004"	"18-29 years"	"18-29"	"Flu like symptoms with vomiting and nausea for 2 weeks following the second shot"
	"1389518-1"	"1389518-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"Flu like symptoms with vomiting and nausea for 2 weeks following the second shot"
	"1389518-1"	"1389518-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Flu like symptoms with vomiting and nausea for 2 weeks following the second shot"
	"1390027-1"	"1390027-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died.  Was found in his bed at approximately 6pm with rigor already set."
	"1390027-1"	"1390027-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died.  Was found in his bed at approximately 6pm with rigor already set."
	"1390027-1"	"1390027-1"	"HISTOLOGY"	"10062005"	"18-29 years"	"18-29"	"The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died.  Was found in his bed at approximately 6pm with rigor already set."
	"1390027-1"	"1390027-1"	"MUSCLE RIGIDITY"	"10028330"	"18-29 years"	"18-29"	"The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died.  Was found in his bed at approximately 6pm with rigor already set."
	"1390027-1"	"1390027-1"	"PAIN"	"10033371"	"18-29 years"	"18-29"	"The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died.  Was found in his bed at approximately 6pm with rigor already set."
	"1390027-1"	"1390027-1"	"SNORING"	"10041235"	"18-29 years"	"18-29"	"The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died.  Was found in his bed at approximately 6pm with rigor already set."
	"1390027-1"	"1390027-1"	"TOXICOLOGIC TEST NORMAL"	"10061383"	"18-29 years"	"18-29"	"The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died.  Was found in his bed at approximately 6pm with rigor already set."
	"1397246-1"	"1397246-1"	"ALANINE AMINOTRANSFERASE INCREASED"	"10001551"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"ALBUMIN GLOBULIN RATIO"	"10001562"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"ASPARTATE AMINOTRANSFERASE INCREASED"	"10003481"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"ASTHENIA"	"10003549"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD ALBUMIN NORMAL"	"10005289"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD ALKALINE PHOSPHATASE NORMAL"	"10005310"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD BILIRUBIN NORMAL"	"10005367"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD CALCIUM DECREASED"	"10005395"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD CHLORIDE INCREASED"	"10005420"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD CREATINE PHOSPHOKINASE NORMAL"	"10005479"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD CREATININE NORMAL"	"10005484"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD GLUCOSE NORMAL"	"10005558"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD LACTIC ACID"	"10005632"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD POTASSIUM NORMAL"	"10005726"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD SODIUM NORMAL"	"10005804"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD TEST"	"10061726"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"BLOOD UREA DECREASED"	"10005850"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"CARBON DIOXIDE NORMAL"	"10007228"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"DIZZINESS"	"10013573"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"ECHOCARDIOGRAM NORMAL"	"10014115"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"FATIGUE"	"10016256"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"GAIT INABILITY"	"10017581"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"HAEMATOCRIT DECREASED"	"10018838"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"HAEMOGLOBIN NORMAL"	"10018890"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"HYPOPHAGIA"	"10063743"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"PLATELET COUNT NORMAL"	"10035530"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"PROTEIN TOTAL NORMAL"	"10037017"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"PYREXIA"	"10037660"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"SINUS RHYTHM"	"10048815"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"SUPRAVENTRICULAR EXTRASYSTOLES"	"10042602"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1397246-1"	"1397246-1"	"WHITE BLOOD CELL COUNT NORMAL"	"10047944"	"18-29 years"	"18-29"	"HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness."
	"1403396-1"	"1403396-1"	"CHILLS"	"10008531"	"18-29 years"	"18-29"	"On Friday night, April 16,2021, after working all day for his job, Pt told his roomates that he wasn't feeling well, was throwing up, had the chills and was going to lay down. When the roomates didn't see him Monday morning, April 19, 2021, they went into his room and found him unresponsive. The medical examiner ruled death due to cancer which appears incorrect considering the evidence."
	"1403396-1"	"1403396-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"On Friday night, April 16,2021, after working all day for his job, Pt told his roomates that he wasn't feeling well, was throwing up, had the chills and was going to lay down. When the roomates didn't see him Monday morning, April 19, 2021, they went into his room and found him unresponsive. The medical examiner ruled death due to cancer which appears incorrect considering the evidence."
	"1403396-1"	"1403396-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"On Friday night, April 16,2021, after working all day for his job, Pt told his roomates that he wasn't feeling well, was throwing up, had the chills and was going to lay down. When the roomates didn't see him Monday morning, April 19, 2021, they went into his room and found him unresponsive. The medical examiner ruled death due to cancer which appears incorrect considering the evidence."
	"1403396-1"	"1403396-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"18-29 years"	"18-29"	"On Friday night, April 16,2021, after working all day for his job, Pt told his roomates that he wasn't feeling well, was throwing up, had the chills and was going to lay down. When the roomates didn't see him Monday morning, April 19, 2021, they went into his room and found him unresponsive. The medical examiner ruled death due to cancer which appears incorrect considering the evidence."
	"1403396-1"	"1403396-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"On Friday night, April 16,2021, after working all day for his job, Pt told his roomates that he wasn't feeling well, was throwing up, had the chills and was going to lay down. When the roomates didn't see him Monday morning, April 19, 2021, they went into his room and found him unresponsive. The medical examiner ruled death due to cancer which appears incorrect considering the evidence."
	"1407929-1"	"1407929-1"	"BLOOD TEST"	"10061726"	"18-29 years"	"18-29"	"Decedent passed away from causes not yet determined"
	"1407929-1"	"1407929-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Decedent passed away from causes not yet determined"
	"1407929-1"	"1407929-1"	"TOXICOLOGIC TEST"	"10061384"	"18-29 years"	"18-29"	"Decedent passed away from causes not yet determined"
	"1411734-1"	"1411734-1"	"ANAEMIA"	"10002034"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"BLOOD TEST"	"10061726"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"CARDIOMEGALY"	"10007632"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"HYPOKALAEMIA"	"10021015"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"HYPOXIA"	"10021143"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"LUNG INFILTRATION"	"10025102"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"OBESITY"	"10029883"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"RENAL FAILURE"	"10038435"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"RESPIRATORY DISTRESS"	"10038687"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1411734-1"	"1411734-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"18-29 years"	"18-29"	"Symptoms started with tightness of muscles and body aches, tightness of chest, increased blood pressure, herpes simplex A mouth sores - saw PMD received muscle relaxer, and antibiotic cream... in the 30 days prior to last event she had been having dizzy spells, chills, hot flashes, shortness of breqth, tightness of chest, darkened urine, muscle cramping and knotting, pitting edema, halo discoloration lower right extremity (she wasnt one to complain and thought her symptoms were from use of muscle relaxer) - woke AM 6/11/2021 with severe shortness of breath and was taken to ER - diagnosed with obesity, cardiomegaly, renal failure, severe anemia, hypoxia, and hypokalemia, she went into respiratory distress AM 6/12/2021 and then went into cardiac arrest.  She died as a result."
	"1417142-1"	"1417142-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"19-year-old male presenting for evaluation due to ongoing nausea and vomiting.  Patient says he has had vomiting for approximately 4 days.  Admits to daily marijuana use secondary to IBS.  He states that he was in the emergency department yesterday and told that he has a acute viral infection.  States that he struggled to keep food or liquid down even after discharge home.  Patient denies other illicit substance abuse.  Patient discharged with ondansetron. Of note, patient Qtc >600ms before discharge."
	"1417142-1"	"1417142-1"	"VIRAL INFECTION"	"10047461"	"18-29 years"	"18-29"	"19-year-old male presenting for evaluation due to ongoing nausea and vomiting.  Patient says he has had vomiting for approximately 4 days.  Admits to daily marijuana use secondary to IBS.  He states that he was in the emergency department yesterday and told that he has a acute viral infection.  States that he struggled to keep food or liquid down even after discharge home.  Patient denies other illicit substance abuse.  Patient discharged with ondansetron. Of note, patient Qtc >600ms before discharge."
	"1417142-1"	"1417142-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"19-year-old male presenting for evaluation due to ongoing nausea and vomiting.  Patient says he has had vomiting for approximately 4 days.  Admits to daily marijuana use secondary to IBS.  He states that he was in the emergency department yesterday and told that he has a acute viral infection.  States that he struggled to keep food or liquid down even after discharge home.  Patient denies other illicit substance abuse.  Patient discharged with ondansetron. Of note, patient Qtc >600ms before discharge."
	"1420630-1"	"1420630-1"	"CHEST PAIN"	"10008479"	"6-17 years"	"6-17"	"~4 weeks after the 2nd dose of Pfizer, patient presented to the hospital with chest pain; had pericardial effusion. Initially improved but then had decompensation, prolonged hospitalization. Diagnosed with hemophagocytic lymphohistocytosis (HLH) and ultimately died."
	"1420630-1"	"1420630-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"~4 weeks after the 2nd dose of Pfizer, patient presented to the hospital with chest pain; had pericardial effusion. Initially improved but then had decompensation, prolonged hospitalization. Diagnosed with hemophagocytic lymphohistocytosis (HLH) and ultimately died."
	"1420630-1"	"1420630-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"6-17 years"	"6-17"	"~4 weeks after the 2nd dose of Pfizer, patient presented to the hospital with chest pain; had pericardial effusion. Initially improved but then had decompensation, prolonged hospitalization. Diagnosed with hemophagocytic lymphohistocytosis (HLH) and ultimately died."
	"1420630-1"	"1420630-1"	"HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS"	"10071583"	"6-17 years"	"6-17"	"~4 weeks after the 2nd dose of Pfizer, patient presented to the hospital with chest pain; had pericardial effusion. Initially improved but then had decompensation, prolonged hospitalization. Diagnosed with hemophagocytic lymphohistocytosis (HLH) and ultimately died."
	"1420630-1"	"1420630-1"	"PERICARDIAL EFFUSION"	"10034474"	"6-17 years"	"6-17"	"~4 weeks after the 2nd dose of Pfizer, patient presented to the hospital with chest pain; had pericardial effusion. Initially improved but then had decompensation, prolonged hospitalization. Diagnosed with hemophagocytic lymphohistocytosis (HLH) and ultimately died."
	"1420762-1"	"1420762-1"	"AUTOPSY"	"10050117"	"6-17 years"	"6-17"	"Cardiac arrest without resuscitation.  Unknown cause of cardiac arrest. Awaiting autopsy report."
	"1420762-1"	"1420762-1"	"CARDIAC ARREST"	"10007515"	"6-17 years"	"6-17"	"Cardiac arrest without resuscitation.  Unknown cause of cardiac arrest. Awaiting autopsy report."
	"1427855-1"	"1427855-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"PATIENT'S MOTHER REPORTED TO PHARMACY THAT PATIENT DIED 6 DAYS AFTER RECEIVING THE JANSSEN COVID 19 VACCINE."
	"1431289-1"	"1431289-1"	"ANGIOGRAM CEREBRAL ABNORMAL"	"10052906"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"APNOEA TEST ABNORMAL"	"10074913"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"ARTERIOVENOUS MALFORMATION"	"10003193"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"BLOOD SODIUM INCREASED"	"10005803"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"BRAIN DEATH"	"10049054"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"BRAIN HERNIATION"	"10006126"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"CARDIAC ARREST"	"10007515"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"CENTRAL NERVOUS SYSTEM LESION"	"10051290"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"CEREBELLAR HAEMORRHAGE"	"10008030"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"COVID-19"	"10084268"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"HAEMORRHAGE INTRACRANIAL"	"10018985"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"HYPERNATRAEMIA"	"10020679"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"HYPOTENSION"	"10021097"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"INTENSIVE CARE"	"10022519"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"MECHANICAL VENTILATION"	"10067221"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"NEOPLASM"	"10028980"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"RESUSCITATION"	"10038749"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"SCAN WITH CONTRAST"	"10059696"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1431289-1"	"1431289-1"	"SINUS TACHYCARDIA"	"10040752"	"6-17 years"	"6-17"	""Date of Admission: 6/19/2021 Date of Death: 6/20/2021  Primary Care Physician: No primary care provider on file.   REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor).   BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain.   Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death.  Official cause of death was brainstem herniation from intracranial hemorrhage.    Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36.     HOSPITAL COURSE BY PROBLEM:   FEN/Renal/Endo:  #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate.  His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic.  He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr.    CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min.   In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done.  Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered.   Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient.  Both titrated to effect.   Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol.  He had no primary pulmonary disease during this admission.   Neuro:  #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient's hospitalization.      PERTINENT STUDIES & CONSULTS:  Pediatric neurology Neurosurgery    PENDING TESTS RESULTS: None   RECOMMENDATIONS AND FOLLOWUP: None   No future appointments.   PHYSICAL EXAMINATION: BP 108/78  | Pulse (!) 144  | Temp 36.5 ¦C (97.7 ¦F)  | Resp (!) 15  | Ht 1.65 m (5' 4.96"")  | Wt 46.5 kg (102 lb 8.2 oz)  | SpO2 99%  | BMI 17.08 kg/m¦   Estimated body mass index is 17.08 kg/m¦ as calculated from the following:   Height as of this encounter: 1.65 m (5' 4.96"").   Weight as of this encounter: 46.5 kg (102 lb 8.2 oz).   ALLERGIES  No Known Drug Allergies""
	"1440769-1"	"1440769-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Patient was gone out for a run on 28th May. While running, he collapsed suddenly. Onlookers called 911 and they tried to revive him but he died on the spot. his autopsy result is still pending. He had no history of any illness and had been a healthy individual.  He used to exercise regularly. He had received his second dose of vaccine that month on 13th May and had faced expected symptoms like fever and chills that only lasted for 2 days."
	"1440769-1"	"1440769-1"	"CHILLS"	"10008531"	"18-29 years"	"18-29"	"Patient was gone out for a run on 28th May. While running, he collapsed suddenly. Onlookers called 911 and they tried to revive him but he died on the spot. his autopsy result is still pending. He had no history of any illness and had been a healthy individual.  He used to exercise regularly. He had received his second dose of vaccine that month on 13th May and had faced expected symptoms like fever and chills that only lasted for 2 days."
	"1440769-1"	"1440769-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient was gone out for a run on 28th May. While running, he collapsed suddenly. Onlookers called 911 and they tried to revive him but he died on the spot. his autopsy result is still pending. He had no history of any illness and had been a healthy individual.  He used to exercise regularly. He had received his second dose of vaccine that month on 13th May and had faced expected symptoms like fever and chills that only lasted for 2 days."
	"1440769-1"	"1440769-1"	"PYREXIA"	"10037660"	"18-29 years"	"18-29"	"Patient was gone out for a run on 28th May. While running, he collapsed suddenly. Onlookers called 911 and they tried to revive him but he died on the spot. his autopsy result is still pending. He had no history of any illness and had been a healthy individual.  He used to exercise regularly. He had received his second dose of vaccine that month on 13th May and had faced expected symptoms like fever and chills that only lasted for 2 days."
	"1440769-1"	"1440769-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"Patient was gone out for a run on 28th May. While running, he collapsed suddenly. Onlookers called 911 and they tried to revive him but he died on the spot. his autopsy result is still pending. He had no history of any illness and had been a healthy individual.  He used to exercise regularly. He had received his second dose of vaccine that month on 13th May and had faced expected symptoms like fever and chills that only lasted for 2 days."
	"1440769-1"	"1440769-1"	"SYNCOPE"	"10042772"	"18-29 years"	"18-29"	"Patient was gone out for a run on 28th May. While running, he collapsed suddenly. Onlookers called 911 and they tried to revive him but he died on the spot. his autopsy result is still pending. He had no history of any illness and had been a healthy individual.  He used to exercise regularly. He had received his second dose of vaccine that month on 13th May and had faced expected symptoms like fever and chills that only lasted for 2 days."
	"1443187-1"	"1443187-1"	"CARDIOMEGALY"	"10007632"	"18-29 years"	"18-29"	"Unexpected death. Coroner reported enlarged heart, enlarged liver."
	"1443187-1"	"1443187-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Unexpected death. Coroner reported enlarged heart, enlarged liver."
	"1443187-1"	"1443187-1"	"HEPATOMEGALY"	"10019842"	"18-29 years"	"18-29"	"Unexpected death. Coroner reported enlarged heart, enlarged liver."
	"1446849-1"	"1446849-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"death"
	"1458126-1"	"1458126-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Father of patient came to store pharmacy to inform us of his son's passing. He stated patient died 5 days after receiving his Moderna vaccine on 6/13/2021 due to blood in the lungs. He stated the autopsy has not been done yet to confirm his death, however he was curious of the possibility. I contacted Moderna on July 8th at 4:30pm and spoke to a pharmaceutical representative of Moderna regarding possible side effects of the vaccine."
	"1458126-1"	"1458126-1"	"PULMONARY HAEMORRHAGE"	"10037394"	"18-29 years"	"18-29"	"Father of patient came to store pharmacy to inform us of his son's passing. He stated patient died 5 days after receiving his Moderna vaccine on 6/13/2021 due to blood in the lungs. He stated the autopsy has not been done yet to confirm his death, however he was curious of the possibility. I contacted Moderna on July 8th at 4:30pm and spoke to a pharmaceutical representative of Moderna regarding possible side effects of the vaccine."
	"1461829-1"	"1461829-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Dead"
	"1464651-1"	"1464651-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"This was a J&J vaccine but I didn't see that as a choice in the drop down. My son passed away on June 5 2021.  He had severe nausea"
	"1464651-1"	"1464651-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"This was a J&J vaccine but I didn't see that as a choice in the drop down. My son passed away on June 5 2021.  He had severe nausea"
	"1466009-1"	"1466009-1"	"AUTOPSY"	"10050117"	"6-17 years"	"6-17"	"My son died, while taking his math class on Zoom. We are waiting for the autopsy because the doctors did not find anything. He was a healthy boy, he had a good academic index, he wanted to be a civil engineer. He was the best thing in my life."
	"1466009-1"	"1466009-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"My son died, while taking his math class on Zoom. We are waiting for the autopsy because the doctors did not find anything. He was a healthy boy, he had a good academic index, he wanted to be a civil engineer. He was the best thing in my life."
	"1470249-1"	"1470249-1"	"CHILLS"	"10008531"	"18-29 years"	"18-29"	"The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn't eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn't keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead."
	"1470249-1"	"1470249-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn't eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn't keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead."
	"1470249-1"	"1470249-1"	"FEEDING DISORDER"	"10061148"	"18-29 years"	"18-29"	"The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn't eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn't keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead."
	"1470249-1"	"1470249-1"	"FEELING ABNORMAL"	"10016322"	"18-29 years"	"18-29"	"The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn't eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn't keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead."
	"1470249-1"	"1470249-1"	"FEELING OF BODY TEMPERATURE CHANGE"	"10061458"	"18-29 years"	"18-29"	"The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn't eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn't keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead."
	"1470249-1"	"1470249-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn't eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn't keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead."
	"1470249-1"	"1470249-1"	"ILLNESS"	"10080284"	"18-29 years"	"18-29"	"The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn't eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn't keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead."
	"1470249-1"	"1470249-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn't eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn't keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead."
	"1475434-1"	"1475434-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"The patient died 6 days after receiving dose #2"
	"1481758-1"	"1481758-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"passed away; blood in lungs; This spontaneous case was reported by a pharmacist and describes the occurrence of DEATH (passed away) and PULMONARY HAEMORRHAGE (blood in lungs) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036C21A) for COVID-19 vaccination.     No Medical History information was reported.    On 13-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Jun-2021, the patient experienced DEATH (passed away) (seriousness criteria death and medically significant) and PULMONARY HAEMORRHAGE (blood in lungs) (seriousness criteria death and medically significant). The patient died on 18-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed.        The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.   For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments.   No relevant concomitant medications were reported. No treatment information was provided.  Company Comment: Very limited information regarding the events has been provided at this time.  Further information is expected.; Sender's Comments: Very limited information regarding the events has been provided at this time.  Further information is expected.; Reported Cause(s) of Death: unknown cause of death"
	"1481758-1"	"1481758-1"	"PULMONARY HAEMORRHAGE"	"10037394"	"18-29 years"	"18-29"	"passed away; blood in lungs; This spontaneous case was reported by a pharmacist and describes the occurrence of DEATH (passed away) and PULMONARY HAEMORRHAGE (blood in lungs) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036C21A) for COVID-19 vaccination.     No Medical History information was reported.    On 13-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Jun-2021, the patient experienced DEATH (passed away) (seriousness criteria death and medically significant) and PULMONARY HAEMORRHAGE (blood in lungs) (seriousness criteria death and medically significant). The patient died on 18-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed.        The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.   For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments.   No relevant concomitant medications were reported. No treatment information was provided.  Company Comment: Very limited information regarding the events has been provided at this time.  Further information is expected.; Sender's Comments: Very limited information regarding the events has been provided at this time.  Further information is expected.; Reported Cause(s) of Death: unknown cause of death"
	"1486784-1"	"1486784-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"18-29 years"	"18-29"	"Lower extremity deep vein thromboses, pulmonary thromboses, cerebral thromboses and hemorrhage, death"
	"1486784-1"	"1486784-1"	"CEREBRAL THROMBOSIS"	"10008132"	"18-29 years"	"18-29"	"Lower extremity deep vein thromboses, pulmonary thromboses, cerebral thromboses and hemorrhage, death"
	"1486784-1"	"1486784-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Lower extremity deep vein thromboses, pulmonary thromboses, cerebral thromboses and hemorrhage, death"
	"1486784-1"	"1486784-1"	"DEEP VEIN THROMBOSIS"	"10051055"	"18-29 years"	"18-29"	"Lower extremity deep vein thromboses, pulmonary thromboses, cerebral thromboses and hemorrhage, death"
	"1486784-1"	"1486784-1"	"PULMONARY THROMBOSIS"	"10037437"	"18-29 years"	"18-29"	"Lower extremity deep vein thromboses, pulmonary thromboses, cerebral thromboses and hemorrhage, death"
	"1486852-1"	"1486852-1"	"BLOOD PH DECREASED"	"10005706"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"CARDIOVERSION"	"10007661"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"CONFUSIONAL STATE"	"10010305"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"EJECTION FRACTION DECREASED"	"10050528"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"LABORATORY TEST"	"10059938"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"SEIZURE"	"10039906"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1486852-1"	"1486852-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"18-29 years"	"18-29"	"4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021"
	"1497990-1"	"1497990-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death"
	"1498080-1"	"1498080-1"	"RESUSCITATION"	"10038749"	"6-17 years"	"6-17"	"7/22/2021  Child collapsed on soccer field while playing soccer at a local camp.  CPR was initiated immediately.  EMS arrived and found patient in vtac.  Shock x 5.  ACLS, intubation attempted.  Transported to Medical Center.  Patient had covid in April 2021.  Dx in May 2021 hypertrophic cardiomyopathy.  Started on lopressor 25mg BID.  Patient had reported to parents that he had not recently taken his medications.  Patient had his second covid vaccine on Sunday 7/18/2021."
	"1498080-1"	"1498080-1"	"SYNCOPE"	"10042772"	"6-17 years"	"6-17"	"7/22/2021  Child collapsed on soccer field while playing soccer at a local camp.  CPR was initiated immediately.  EMS arrived and found patient in vtac.  Shock x 5.  ACLS, intubation attempted.  Transported to Medical Center.  Patient had covid in April 2021.  Dx in May 2021 hypertrophic cardiomyopathy.  Started on lopressor 25mg BID.  Patient had reported to parents that he had not recently taken his medications.  Patient had his second covid vaccine on Sunday 7/18/2021."
	"1498080-1"	"1498080-1"	"VENTRICULAR TACHYCARDIA"	"10047302"	"6-17 years"	"6-17"	"7/22/2021  Child collapsed on soccer field while playing soccer at a local camp.  CPR was initiated immediately.  EMS arrived and found patient in vtac.  Shock x 5.  ACLS, intubation attempted.  Transported to Medical Center.  Patient had covid in April 2021.  Dx in May 2021 hypertrophic cardiomyopathy.  Started on lopressor 25mg BID.  Patient had reported to parents that he had not recently taken his medications.  Patient had his second covid vaccine on Sunday 7/18/2021."
	"1500834-1"	"1500834-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"She got very sick, was already not feeling well before vaccine.  She died may 15, 2021."
	"1500834-1"	"1500834-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"She got very sick, was already not feeling well before vaccine.  She died may 15, 2021."
	"1500862-1"	"1500862-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"On first day, patient was feeling tired, dizzy and foggy and 18 hours later was found dead on the floor."
	"1500862-1"	"1500862-1"	"DIZZINESS"	"10013573"	"18-29 years"	"18-29"	"On first day, patient was feeling tired, dizzy and foggy and 18 hours later was found dead on the floor."
	"1500862-1"	"1500862-1"	"FATIGUE"	"10016256"	"18-29 years"	"18-29"	"On first day, patient was feeling tired, dizzy and foggy and 18 hours later was found dead on the floor."
	"1500862-1"	"1500862-1"	"FEELING ABNORMAL"	"10016322"	"18-29 years"	"18-29"	"On first day, patient was feeling tired, dizzy and foggy and 18 hours later was found dead on the floor."
	"1502047-1"	"1502047-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Patient found deceased in her bed on june 12, 2021, reported to Strongsville Police Department at 10:15am., taken to Cuyahoga Medical Examiner's Office the same day. Autopsy done. Results still pending for 4-5 months."
	"1502047-1"	"1502047-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient found deceased in her bed on june 12, 2021, reported to Strongsville Police Department at 10:15am., taken to Cuyahoga Medical Examiner's Office the same day. Autopsy done. Results still pending for 4-5 months."
	"1505250-1"	"1505250-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"6-17 years"	"6-17"	"patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death."
	"1505250-1"	"1505250-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death."
	"1505250-1"	"1505250-1"	"FULL BLOOD COUNT"	"10017411"	"6-17 years"	"6-17"	"patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death."
	"1505250-1"	"1505250-1"	"METABOLIC FUNCTION TEST NORMAL"	"10062192"	"6-17 years"	"6-17"	"patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death."
	"1505250-1"	"1505250-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"6-17 years"	"6-17"	"patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death."
	"1505250-1"	"1505250-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"6-17 years"	"6-17"	"patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death."
	"1505250-1"	"1505250-1"	"VENTRICULAR TACHYCARDIA"	"10047302"	"6-17 years"	"6-17"	"patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death."
	"1510268-1"	"1510268-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient died."
	"1510268-1"	"1510268-1"	"FEELING ABNORMAL"	"10016322"	"18-29 years"	"18-29"	"Patient died."
	"1510268-1"	"1510268-1"	"SEIZURE"	"10039906"	"18-29 years"	"18-29"	"Patient died."
	"1513095-1"	"1513095-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death.  Died on 7-9-21 (approximately 24 hours after vaccine)."
	"1535195-1"	"1535195-1"	"ABDOMINAL DISCOMFORT"	"10000059"	"18-29 years"	"18-29"	"Patient experienced flu-like symptoms and an upset stomach and died 60-72 hours later. Immediate cause of death is still pending further study."
	"1535195-1"	"1535195-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient experienced flu-like symptoms and an upset stomach and died 60-72 hours later. Immediate cause of death is still pending further study."
	"1535195-1"	"1535195-1"	"INFLUENZA LIKE ILLNESS"	"10022004"	"18-29 years"	"18-29"	"Patient experienced flu-like symptoms and an upset stomach and died 60-72 hours later. Immediate cause of death is still pending further study."
	"1542107-1"	"1542107-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"18-29 years"	"18-29"	"CARDIOPULMONARY ARREST"
	"1574026-1"	"1574026-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Pt developed acute TTP ~3 weeks post dose and subsequently passed away."
	"1574026-1"	"1574026-1"	"PLATELET COUNT DECREASED"	"10035528"	"18-29 years"	"18-29"	"Pt developed acute TTP ~3 weeks post dose and subsequently passed away."
	"1574026-1"	"1574026-1"	"THROMBOTIC THROMBOCYTOPENIC PURPURA"	"10043648"	"18-29 years"	"18-29"	"Pt developed acute TTP ~3 weeks post dose and subsequently passed away."
	"1574608-1"	"1574608-1"	"ARRHYTHMIA"	"10003119"	"18-29 years"	"18-29"	""On 8/2/21, client had a reported sudden death in the morning after complaining of ""being unable to hear"" and dizziness.  EMS was called to the site and CPR was attempted by employees until EMS arrived.  Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized.  An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified.  Medical Director Dr. and she was notified.  Both the Covid 19 and autopsy reports should be available through Hospital.""
	"1574608-1"	"1574608-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	""On 8/2/21, client had a reported sudden death in the morning after complaining of ""being unable to hear"" and dizziness.  EMS was called to the site and CPR was attempted by employees until EMS arrived.  Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized.  An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified.  Medical Director Dr. and she was notified.  Both the Covid 19 and autopsy reports should be available through Hospital.""
	"1574608-1"	"1574608-1"	"COVID-19"	"10084268"	"18-29 years"	"18-29"	""On 8/2/21, client had a reported sudden death in the morning after complaining of ""being unable to hear"" and dizziness.  EMS was called to the site and CPR was attempted by employees until EMS arrived.  Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized.  An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified.  Medical Director Dr. and she was notified.  Both the Covid 19 and autopsy reports should be available through Hospital.""
	"1574608-1"	"1574608-1"	"DEAFNESS"	"10011878"	"18-29 years"	"18-29"	""On 8/2/21, client had a reported sudden death in the morning after complaining of ""being unable to hear"" and dizziness.  EMS was called to the site and CPR was attempted by employees until EMS arrived.  Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized.  An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified.  Medical Director Dr. and she was notified.  Both the Covid 19 and autopsy reports should be available through Hospital.""
	"1574608-1"	"1574608-1"	"DIZZINESS"	"10013573"	"18-29 years"	"18-29"	""On 8/2/21, client had a reported sudden death in the morning after complaining of ""being unable to hear"" and dizziness.  EMS was called to the site and CPR was attempted by employees until EMS arrived.  Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized.  An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified.  Medical Director Dr. and she was notified.  Both the Covid 19 and autopsy reports should be available through Hospital.""
	"1574608-1"	"1574608-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	""On 8/2/21, client had a reported sudden death in the morning after complaining of ""being unable to hear"" and dizziness.  EMS was called to the site and CPR was attempted by employees until EMS arrived.  Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized.  An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified.  Medical Director Dr. and she was notified.  Both the Covid 19 and autopsy reports should be available through Hospital.""
	"1574608-1"	"1574608-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"18-29 years"	"18-29"	""On 8/2/21, client had a reported sudden death in the morning after complaining of ""being unable to hear"" and dizziness.  EMS was called to the site and CPR was attempted by employees until EMS arrived.  Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized.  An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified.  Medical Director Dr. and she was notified.  Both the Covid 19 and autopsy reports should be available through Hospital.""
	"1574608-1"	"1574608-1"	"SUDDEN DEATH"	"10042434"	"18-29 years"	"18-29"	""On 8/2/21, client had a reported sudden death in the morning after complaining of ""being unable to hear"" and dizziness.  EMS was called to the site and CPR was attempted by employees until EMS arrived.  Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized.  An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified.  Medical Director Dr. and she was notified.  Both the Covid 19 and autopsy reports should be available through Hospital.""
	"1582506-1"	"1582506-1"	"ACUTE HEPATIC FAILURE"	"10000804"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"ACUTE LEFT VENTRICULAR FAILURE"	"10063081"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"ANGIOGRAM CEREBRAL ABNORMAL"	"10052906"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"BRAIN DEATH"	"10049054"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"BRAIN HERNIATION"	"10006126"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"BRAIN OEDEMA"	"10048962"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"CARDIAC FAILURE"	"10007554"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"CARDIOGENIC SHOCK"	"10007625"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"DISTRIBUTIVE SHOCK"	"10070559"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"GASTROINTESTINAL HAEMORRHAGE"	"10017955"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"HAEMATEMESIS"	"10018830"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"HYPERAMMONAEMIA"	"10020575"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"HYPERVENTILATION"	"10020910"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"INTENSIVE CARE"	"10022519"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"INTRACRANIAL PRESSURE INCREASED"	"10022773"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"LABORATORY TEST"	"10059938"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"LACTIC ACIDOSIS"	"10023676"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"MENTAL STATUS CHANGES"	"10048294"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"PUPIL FIXED"	"10037515"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582506-1"	"1582506-1"	"RESPIRATORY DISTRESS"	"10038687"	"18-29 years"	"18-29"	"vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure"
	"1582987-1"	"1582987-1"	"ARTERIOVENOUS MALFORMATION"	"10003193"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1582987-1"	"1582987-1"	"CARDIOVERSION"	"10007661"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1582987-1"	"1582987-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1582987-1"	"1582987-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1582987-1"	"1582987-1"	"CYANOSIS"	"10011703"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1582987-1"	"1582987-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1582987-1"	"1582987-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1582987-1"	"1582987-1"	"MECHANICAL VENTILATION"	"10067221"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1582987-1"	"1582987-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?"
	"1586936-1"	"1586936-1"	"APHASIA"	"10002948"	"18-29 years"	"18-29"	""RESIDENT REC'D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334.  PROGRESS NOTE FROM FACILITY READS:  8/18/21  @ 15:11-  ""RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST.""  8/18/21  @ 20:50-  ""RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED  NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO  ER, RESIDENT FAMILY NOTIFIED,  RN NOTIFIED.""   RN STATES THEY REC'D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.""
	"1586936-1"	"1586936-1"	"BLOOD PRESSURE IMMEASURABLE"	"10005748"	"18-29 years"	"18-29"	""RESIDENT REC'D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334.  PROGRESS NOTE FROM FACILITY READS:  8/18/21  @ 15:11-  ""RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST.""  8/18/21  @ 20:50-  ""RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED  NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO  ER, RESIDENT FAMILY NOTIFIED,  RN NOTIFIED.""   RN STATES THEY REC'D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.""
	"1586936-1"	"1586936-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	""RESIDENT REC'D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334.  PROGRESS NOTE FROM FACILITY READS:  8/18/21  @ 15:11-  ""RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST.""  8/18/21  @ 20:50-  ""RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED  NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO  ER, RESIDENT FAMILY NOTIFIED,  RN NOTIFIED.""   RN STATES THEY REC'D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.""
	"1586936-1"	"1586936-1"	"HYPOPNOEA"	"10021079"	"18-29 years"	"18-29"	""RESIDENT REC'D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334.  PROGRESS NOTE FROM FACILITY READS:  8/18/21  @ 15:11-  ""RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST.""  8/18/21  @ 20:50-  ""RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED  NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO  ER, RESIDENT FAMILY NOTIFIED,  RN NOTIFIED.""   RN STATES THEY REC'D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.""
	"1586936-1"	"1586936-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"18-29 years"	"18-29"	""RESIDENT REC'D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334.  PROGRESS NOTE FROM FACILITY READS:  8/18/21  @ 15:11-  ""RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST.""  8/18/21  @ 20:50-  ""RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED  NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO  ER, RESIDENT FAMILY NOTIFIED,  RN NOTIFIED.""   RN STATES THEY REC'D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.""
	"1624122-1"	"1624122-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Expired"
	"1624319-1"	"1624319-1"	"AMMONIA INCREASED"	"10001946"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"ARRHYTHMIA"	"10003119"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"BLOOD LACTIC ACID"	"10005632"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"CARBON DIOXIDE DECREASED"	"10007223"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"MYOCARDITIS"	"10028606"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"PROCALCITONIN"	"10064051"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"SEIZURE"	"10039906"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"SEIZURE LIKE PHENOMENA"	"10071048"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1624319-1"	"1624319-1"	"STATUS EPILEPTICUS"	"10041962"	"18-29 years"	"18-29"	"er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility.  tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias.  Pt was intubated and never recovered despite 3 days care and resuscitation.  Autopsy report available to me indicates lymphocytic myocarditis as  primary cause of death"
	"1627712-1"	"1627712-1"	"COMPLETED SUICIDE"	"10010144"	"18-29 years"	"18-29"	"Suicidal ideations began immediately.  Suicide by gunshot completed July 27, 2021"
	"1627712-1"	"1627712-1"	"IMMEDIATE POST-INJECTION REACTION"	"10067142"	"18-29 years"	"18-29"	"Suicidal ideations began immediately.  Suicide by gunshot completed July 27, 2021"
	"1627712-1"	"1627712-1"	"SUICIDAL IDEATION"	"10042458"	"18-29 years"	"18-29"	"Suicidal ideations began immediately.  Suicide by gunshot completed July 27, 2021"
	"1632726-1"	"1632726-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient found in early morning hours by family member.  Unfortunately he had already expired with rigor."
	"1632726-1"	"1632726-1"	"MUSCLE RIGIDITY"	"10028330"	"18-29 years"	"18-29"	"Patient found in early morning hours by family member.  Unfortunately he had already expired with rigor."
	"1636967-1"	"1636967-1"	"ANGIOGRAM ABNORMAL"	"10060956"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"ASPIRATION"	"10003504"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"CENTRAL PAIN SYNDROME"	"10064012"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"CEREBELLAR STROKE"	"10079062"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"CEREBRAL INFARCTION"	"10008118"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"CEREBRAL MASS EFFECT"	"10067086"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"COMA SCALE ABNORMAL"	"10069709"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"COMPUTERISED TOMOGRAM NECK"	"10082961"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"DIZZINESS"	"10013573"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"DYSARTHRIA"	"10013887"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"ELECTROENCEPHALOGRAM"	"10014407"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"HEPARIN-INDUCED THROMBOCYTOPENIA TEST"	"10050829"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"HYDROCEPHALUS"	"10020508"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"ISCHAEMIC STROKE"	"10061256"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"MAGNETIC RESONANCE IMAGING HEAD ABNORMAL"	"10085256"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"NIH STROKE SCALE ABNORMAL"	"10065531"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"PARANASAL SINUS DISCOMFORT"	"10052438"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"PERFUSION BRAIN SCAN"	"10079705"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"PLATELET COUNT NORMAL"	"10035530"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"POSTERIOR FOSSA SYNDROME"	"10069579"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"SEIZURE"	"10039906"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"SEIZURE LIKE PHENOMENA"	"10071048"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"STATUS EPILEPTICUS"	"10041962"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"THALAMIC INFARCTION"	"10064961"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1636967-1"	"1636967-1"	"TINNITUS"	"10043882"	"18-29 years"	"18-29"	"Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter.  Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago."
	"1646186-1"	"1646186-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"passed away 19Jun2021; This is a spontaneous report from a contactable consumer (patient's mother). A 25-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 23May2021 (Lot Number: EW0172) (at age of 25-year-old) as DOSE 1, SINGLE for covid-19 immunisation.  Medical history included diagnosed with an enlarged vessel sized heart.  The patient's concomitant medications were not reported. The patient experienced passed away on 19Jun2021.An autopsy was performed and results were not provided. Two days after the first vaccine was when the information came out about males 20-30 getting inflammation of the heart. The patient's mother told him not to take the second shot. Then, this happened. She doesn't have the results of the autopsy yet. She believed the Pfizer vaccine escalated his death. He did get diagnosed with an enlarged vessel sized heart. He got it because he thought he was doing the right thing.  There was no history of all previous immunization with the Pfizer vaccine considered as suspect.  No additional Vaccines Administered on Same Date of the Pfizer Suspect. No Prior Vaccinations (within 4 weeks).  Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: passed away 19Jun2021"
	"1658459-1"	"1658459-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Specifically unknown, but patient (he's now deceased) was concerned about throwing up so much that he'd lose his stomach lining."
	"1658459-1"	"1658459-1"	"CARDIAC DISORDER"	"10061024"	"18-29 years"	"18-29"	"Specifically unknown, but patient (he's now deceased) was concerned about throwing up so much that he'd lose his stomach lining."
	"1658459-1"	"1658459-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Specifically unknown, but patient (he's now deceased) was concerned about throwing up so much that he'd lose his stomach lining."
	"1658459-1"	"1658459-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Specifically unknown, but patient (he's now deceased) was concerned about throwing up so much that he'd lose his stomach lining."
	"1689212-1"	"1689212-1"	"COVID-19"	"10084268"	"6-17 years"	"6-17"	"SARS COV2 POSITIVE ON 7/20; EXPIRED 8/29/2021"
	"1689212-1"	"1689212-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"SARS COV2 POSITIVE ON 7/20; EXPIRED 8/29/2021"
	"1689212-1"	"1689212-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"6-17 years"	"6-17"	"SARS COV2 POSITIVE ON 7/20; EXPIRED 8/29/2021"
	"1693704-1"	"1693704-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"The decedent was found deceased at home on 05/23/2021. The decedent's cause of death is acute fentanyl toxicity. The pathologist found blood clots in her lungs during autopsy, and she was concerned the blood clots may be related to the vaccine she received on 05/08/2021."
	"1693704-1"	"1693704-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"The decedent was found deceased at home on 05/23/2021. The decedent's cause of death is acute fentanyl toxicity. The pathologist found blood clots in her lungs during autopsy, and she was concerned the blood clots may be related to the vaccine she received on 05/08/2021."
	"1693704-1"	"1693704-1"	"PULMONARY THROMBOSIS"	"10037437"	"18-29 years"	"18-29"	"The decedent was found deceased at home on 05/23/2021. The decedent's cause of death is acute fentanyl toxicity. The pathologist found blood clots in her lungs during autopsy, and she was concerned the blood clots may be related to the vaccine she received on 05/08/2021."
	"1693704-1"	"1693704-1"	"TOXICITY TO VARIOUS AGENTS"	"10070863"	"18-29 years"	"18-29"	"The decedent was found deceased at home on 05/23/2021. The decedent's cause of death is acute fentanyl toxicity. The pathologist found blood clots in her lungs during autopsy, and she was concerned the blood clots may be related to the vaccine she received on 05/08/2021."
	"1694568-1"	"1694568-1"	"AUTOPSY"	"10050117"	"6-17 years"	"6-17"	"pulmonary embolism"
	"1694568-1"	"1694568-1"	"PULMONARY EMBOLISM"	"10037377"	"6-17 years"	"6-17"	"pulmonary embolism"
	"1700329-1"	"1700329-1"	"ABDOMINAL PAIN"	"10000081"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ACTIVATED PARTIAL THROMBOPLASTIN TIME PROLONGED"	"10000636"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ACUTE KIDNEY INJURY"	"10069339"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ACUTE MYOCARDIAL INFARCTION"	"10000891"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ALANINE AMINOTRANSFERASE INCREASED"	"10001551"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ANISOCYTOSIS"	"10002536"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ASPARTATE AMINOTRANSFERASE NORMAL"	"10003482"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BASE EXCESS ABNORMAL"	"10063336"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BASOPHIL COUNT"	"10049695"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BASOPHIL PERCENTAGE DECREASED"	"10052219"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD ALBUMIN DECREASED"	"10005287"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD BICARBONATE DECREASED"	"10005359"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD CALCIUM DECREASED"	"10005395"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD CHLORIDE NORMAL"	"10005421"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD CREATININE NORMAL"	"10005484"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD FIBRINOGEN DECREASED"	"10005520"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD MAGNESIUM NORMAL"	"10005656"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD PH NORMAL"	"10005709"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD POTASSIUM NORMAL"	"10005726"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD SODIUM NORMAL"	"10005804"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BLOOD UREA INCREASED"	"10005851"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"BRONCHOSCOPY ABNORMAL"	"10006480"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"CALCIUM IONISED DECREASED"	"10060898"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"CARBON DIOXIDE ABNORMAL"	"10064156"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"CARBON DIOXIDE DECREASED"	"10007223"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"CATHETERISATION CARDIAC ABNORMAL"	"10007816"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"CORONARY ARTERY OCCLUSION"	"10011086"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"CULTURE"	"10061447"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"EOSINOPHIL COUNT DECREASED"	"10014943"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"EOSINOPHIL PERCENTAGE DECREASED"	"10052221"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"FATIGUE"	"10016256"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"FIBRIN D DIMER"	"10016577"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"FULL BLOOD COUNT"	"10017411"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"HAEMATOCRIT DECREASED"	"10018838"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"HAEMOFILTRATION"	"10053090"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"HAEMORRHAGE"	"10055798"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"HYPOXIA"	"10021143"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"IMMATURE GRANULOCYTE COUNT INCREASED"	"10081727"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"INTENSIVE CARE"	"10022519"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"INTERNATIONAL NORMALISED RATIO INCREASED"	"10022595"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"LUNG ASSIST DEVICE THERAPY"	"10082527"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"LUNG OPACITY"	"10081792"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"LYMPHOCYTE COUNT DECREASED"	"10025256"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"LYMPHOCYTE PERCENTAGE DECREASED"	"10052231"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"MEAN CELL HAEMOGLOBIN CONCENTRATION DECREASED"	"10026991"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"MEAN CELL HAEMOGLOBIN NORMAL"	"10026997"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"MEAN CELL VOLUME INCREASED"	"10027004"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"MEAN PLATELET VOLUME INCREASED"	"10055052"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"MECHANICAL VENTILATION"	"10067221"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"METABOLIC FUNCTION TEST"	"10062191"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"MONOCYTE COUNT"	"10027876"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"MONOCYTE PERCENTAGE DECREASED"	"10052229"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"MYOCARDIAL INFARCTION"	"10028596"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"NEUTROPHIL COUNT INCREASED"	"10029368"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"PCO2 DECREASED"	"10034181"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"PLATELET COUNT DECREASED"	"10035528"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"PO2 DECREASED"	"10035768"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"PROTHROMBIN TIME PROLONGED"	"10037063"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"PULMONARY ALVEOLAR HAEMORRHAGE"	"10037313"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"PULMONARY HAEMORRHAGE"	"10037394"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"PYREXIA"	"10037660"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"RED BLOOD CELL COUNT DECREASED"	"10038153"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"RED BLOOD CELL NUCLEATED MORPHOLOGY PRESENT"	"10038165"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"RED CELL DISTRIBUTION WIDTH INCREASED"	"10053920"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"RIGHT VENTRICULAR FAILURE"	"10039163"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"SEPSIS"	"10040047"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"SEPTIC SHOCK"	"10040070"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"SINUS TACHYCARDIA"	"10040752"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"TACHYCARDIA"	"10043071"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"URINE ANALYSIS NORMAL"	"10061578"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700329-1"	"1700329-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"18-29 years"	"18-29"	"Patient is a 18 y.o. male patient with a past medical history significant for lupus  who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine.      At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6>8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO.    On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl.    Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID    Parents spanish speaking.   Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation.   Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am"
	"1700774-1"	"1700774-1"	"ANION GAP INCREASED"	"10002528"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"ASCITES"	"10003445"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD BICARBONATE DECREASED"	"10005359"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD CHLORIDE DECREASED"	"10005419"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD CREATININE INCREASED"	"10005483"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD GLUCOSE NORMAL"	"10005558"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD LACTIC ACID INCREASED"	"10005635"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD PH DECREASED"	"10005706"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD POTASSIUM NORMAL"	"10005726"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD SODIUM DECREASED"	"10005802"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"BLOOD UREA INCREASED"	"10005851"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"CARDIAC FAILURE"	"10007554"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"CARDIOGENIC SHOCK"	"10007625"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"CARDIOMEGALY"	"10007632"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"COMPUTERISED TOMOGRAM ABDOMEN ABNORMAL"	"10057798"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"CONGESTIVE HEPATOPATHY"	"10084058"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"COVID-19"	"10084268"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"ELECTROCARDIOGRAM ST SEGMENT ELEVATION"	"10014392"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"GLOMERULAR FILTRATION RATE DECREASED"	"10018358"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"HEPATIC FAILURE"	"10019663"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"HEPATOMEGALY"	"10019842"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"HYPERVENTILATION"	"10020910"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"INFLAMMATION"	"10061218"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"METABOLIC ACIDOSIS"	"10027417"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"MYOCARDITIS"	"10028606"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"PCO2 DECREASED"	"10034181"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"PERICARDIAL EFFUSION"	"10034474"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"PNEUMONIA"	"10035664"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"RENAL DISORDER"	"10038428"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"RENAL FAILURE"	"10038435"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1700774-1"	"1700774-1"	"TROPONIN INCREASED"	"10058267"	"18-29 years"	"18-29"	"Death.   Presented to the emergency department with diffuse ST elevations concerning for myocarditis.  His troponin was elevated at 113.  His lactate was 14.  He was in renal failure with a creatinine of 2.97, GFR 26.  D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT.  Upon presentation he was hyperventilating, not complaining of chest pain.  Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4.  O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived.  Cause of death suspected to be myocarditis and cardiogenic shock   In the setting of active COVID-19 infection."
	"1703893-1"	"1703893-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Death occurred 7 days after the second dose"
	"1703893-1"	"1703893-1"	"CARDIOMYOPATHY"	"10007636"	"18-29 years"	"18-29"	"Death occurred 7 days after the second dose"
	"1703893-1"	"1703893-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death occurred 7 days after the second dose"
	"1703893-1"	"1703893-1"	"TOXICOLOGIC TEST NORMAL"	"10061383"	"18-29 years"	"18-29"	"Death occurred 7 days after the second dose"
	"1704467-1"	"1704467-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Not feeling well and headaches"
	"1704467-1"	"1704467-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"Not feeling well and headaches"
	"1704688-1"	"1704688-1"	"ACUTE RESPIRATORY DISTRESS SYNDROME"	"10001052"	"18-29 years"	"18-29"	"presented with cough and increasing dyspnea; positive for COVID; hx of granulomatous polyangiitis and airway strictures; ARDS with intubation, mechanical assistance"
	"1704688-1"	"1704688-1"	"COUGH"	"10011224"	"18-29 years"	"18-29"	"presented with cough and increasing dyspnea; positive for COVID; hx of granulomatous polyangiitis and airway strictures; ARDS with intubation, mechanical assistance"
	"1704688-1"	"1704688-1"	"COVID-19"	"10084268"	"18-29 years"	"18-29"	"presented with cough and increasing dyspnea; positive for COVID; hx of granulomatous polyangiitis and airway strictures; ARDS with intubation, mechanical assistance"
	"1704688-1"	"1704688-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"presented with cough and increasing dyspnea; positive for COVID; hx of granulomatous polyangiitis and airway strictures; ARDS with intubation, mechanical assistance"
	"1704688-1"	"1704688-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"presented with cough and increasing dyspnea; positive for COVID; hx of granulomatous polyangiitis and airway strictures; ARDS with intubation, mechanical assistance"
	"1704688-1"	"1704688-1"	"MECHANICAL VENTILATION"	"10067221"	"18-29 years"	"18-29"	"presented with cough and increasing dyspnea; positive for COVID; hx of granulomatous polyangiitis and airway strictures; ARDS with intubation, mechanical assistance"
	"1704688-1"	"1704688-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"18-29 years"	"18-29"	"presented with cough and increasing dyspnea; positive for COVID; hx of granulomatous polyangiitis and airway strictures; ARDS with intubation, mechanical assistance"
	"1719772-1"	"1719772-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"PATIENT EXPIRED ON 09/20/2021"
	"1727253-1"	"1727253-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient's grandmother found him dead in the bathroom 4 to 4:30 hours after his vaccine. She was not aware of him having complaints. He had vomited in the commode -that was the only comment that she had."
	"1727253-1"	"1727253-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Patient's grandmother found him dead in the bathroom 4 to 4:30 hours after his vaccine. She was not aware of him having complaints. He had vomited in the commode -that was the only comment that she had."
	"1727443-1"	"1727443-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient died on July 7, 2021 of a pulmonary  embolism.  The clots were in his lungs."
	"1727443-1"	"1727443-1"	"PULMONARY EMBOLISM"	"10037377"	"18-29 years"	"18-29"	"Patient died on July 7, 2021 of a pulmonary  embolism.  The clots were in his lungs."
	"1732186-1"	"1732186-1"	"ASTHENIA"	"10003549"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1732186-1"	"1732186-1"	"CARDIOVERSION"	"10007661"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1732186-1"	"1732186-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1732186-1"	"1732186-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1732186-1"	"1732186-1"	"MYOCARDIAL INFARCTION"	"10028596"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1732186-1"	"1732186-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1732186-1"	"1732186-1"	"RESPIRATORY ARREST"	"10038669"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1732186-1"	"1732186-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1732186-1"	"1732186-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom.  That continued off and on all night.  Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak.  H e went back to  bed.  We checked on him around lunch time lying on his bed with his phone in his hand.  He appeared to be trying to text.  I checked on him a few minutes later and he had not moved.  I checked and saw he wasn't breathing.  At that time he had a heart beat.   We called 911 and I started CPR and continued for approx 25 until paramedics arrived.  They bagged him and used defibrillator but could not bring him back."
	"1734141-1"	"1734141-1"	"CARDIOMEGALY"	"10007632"	"6-17 years"	"6-17"	"killed this young man/he died of an enlarged heart (500+ grams); The initial case was missing the following minimum criteria: unidentified reporter. Upon receipt of follow-up information on 20Sep2021, this case now contains all required information to be valid.  This is a spontaneous report from Pfizer sponsored Program, via contactable consumers. A 16-year-old male patient received BNT162B2 via an unspecified route of administration on 19Apr2021 (Lot Number: ER8731; Expiration Date: Jul2021) (at 16-year-old) as dose 1, single for COVID-19 immunisation. The patient's medical history and concomitant medications were not reported. The patient died in 24Apr2021. His father claimed he took the Pfizer vaccine five days before (24Apr2021) he died and that he died of an enlarged heart (500+grams) from Apr2021. It's not reported if autopsy performed.  Follow-up attempts are completed. No further information is expected. ; Reported Cause(s) of Death: died of an enlarged heart"
	"1741267-1"	"1741267-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Patient died and preliminary autopsy revealed Massive pulmonary embolism"
	"1741267-1"	"1741267-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Patient died and preliminary autopsy revealed Massive pulmonary embolism"
	"1741267-1"	"1741267-1"	"PULMONARY EMBOLISM"	"10037377"	"18-29 years"	"18-29"	"Patient died and preliminary autopsy revealed Massive pulmonary embolism"
	"1757635-1"	"1757635-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"fatigue then death"
	"1757635-1"	"1757635-1"	"FATIGUE"	"10016256"	"6-17 years"	"6-17"	"fatigue then death"
	"1760635-1"	"1760635-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Death. My daughter passed away in her sleep ."
	"1760635-1"	"1760635-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death. My daughter passed away in her sleep ."
	"1764974-1"	"1764974-1"	"ARTHRALGIA"	"10003239"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"AUTOPSY"	"10050117"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"DROWNING"	"10013647"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"GENE SEQUENCING"	"10069604"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"INTRACARDIAC MASS"	"10066087"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"MYOCARDIAL NECROSIS"	"10028602"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"MYOCARDITIS"	"10028606"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"PAIN"	"10033371"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"PATHOLOGY TEST"	"10068056"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"SUBGALEAL HAEMORRHAGE"	"10080900"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"TOXICOLOGIC TEST NORMAL"	"10061383"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1764974-1"	"1764974-1"	"VENTRICULAR HYPERTROPHY"	"10047295"	"6-17 years"	"6-17"	""He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends ""Wow, that hurt!"", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.""
	"1765077-1"	"1765077-1"	"ANGIOGRAM PULMONARY NORMAL"	"10002442"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"AORTIC VALVE INCOMPETENCE"	"10002915"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"BRADYCARDIA"	"10006093"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"CHEST PAIN"	"10008479"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"CONDITION AGGRAVATED"	"10010264"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"COUGH"	"10011224"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"ECHOCARDIOGRAM"	"10014113"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"FATIGUE"	"10016256"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"FLAIL CHEST"	"10016747"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"GAZE PALSY"	"10056696"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"HYPOTENSION"	"10021097"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"INTENSIVE CARE"	"10022519"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"LUNG ASSIST DEVICE THERAPY"	"10082527"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"RESPIRATORY DISTRESS"	"10038687"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765077-1"	"1765077-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"an 18-year-old gentleman with a past medical history significant for perimembranous ventricular septal defect and severe aortic valve insufficiency, status post ASD and VSD and aortic valvuloplasty  back in 2004.  He had repeated surgical aortic valvuloplasty with moderate residual aortic valve insufficiency.  He is followed closely by the pediatric cardiology service.  On his last office visit on 1/7/2020, there were concerns regarding increased BMI, elevated systolic blood pressure, and wide pulse pressure.  Need for repeat aortic valve surgery was addressed during the visit.  The cardiac MRI was done in March of 2021 which revealed worsening to severe aortic insufficiency with an increasing left ventricular dilation with a reduced EF of approximately 60% and reduced right ventricular ejection fraction of 66% from previous studies.  The patient was COVID positive in February 2021.  He received the second COVID vaccine back on 6/10/2021.  The patient presented to Emergency Department on 6/12 at approximately 12:30 in the afternoon complaining of shortness of breath, cough as well as nausea and vomiting for approximately 1 week.  He had chest pain and fatigue that had been worsening over the last 48 hours. No fevers. No sick contacts.    A CT angiogram of the chest was obtained which was negative for PE.  After return from that study, a nurse found the patient in severe respiratory distress.  The patient became bradycardic and profoundly hypotensive and then subsequently went into a PEA cardiac arrest at approximately 4:30 p.m. on the 12th.  CPR was initiated.  He was intubated and subsequently placed on venoarterial ECMO  at 1719 that day by the cardiac surgery service.  Post ECMO, the patient's mental status was questionable after the arrest.  He was noted to have rightward gaze by the emergency department physician.  A transthoracic echo was performed at 1815 which demonstrated wide open aortic insufficiency with flail segment.  He was transferred to us as a tertiary care center and escalation of care.  The patient was admitted to the Heart and Vascular ICU team in the adult cardiothoracic surgery service.  Upon arrival to the ICU, the ECMO circuit was changed from a Novalung to the CentriMag ECMO circuit."
	"1765443-1"	"1765443-1"	"ANXIETY"	"10002855"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"CHEST PAIN"	"10008479"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"HYPERTENSION"	"10020772"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"HYPERVENTILATION"	"10020910"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"PULMONARY EMBOLISM"	"10037377"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"RESUSCITATION"	"10038749"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"SYNCOPE"	"10042772"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1765443-1"	"1765443-1"	"TREMOR"	"10044565"	"18-29 years"	"18-29"	"employee of facility.  she came to work and was sitting in locker room and noted by another employee to be hyperventilating/shaking. Coworker got nursing staff who went in to assess her. Employee stated she had been having chest pain on and off for the past few days and that her PCP suggested getting tested for covid. She was again complaining of chest pain, stating she can't breath, and became very anxious. BP was high, HR was in 170's, oxygen was 87. Applied O2 via nonrebreather, contacted EMS. At time of EMS arrival employee fainted x 2 and went into asystole. CPR performed for almost an hour before time of death was called.  medical examination performed post death and determined she had a pulmonary embolism."
	"1780517-1"	"1780517-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Had a heart attack and was gasping for air"
	"1780517-1"	"1780517-1"	"MYOCARDIAL INFARCTION"	"10028596"	"18-29 years"	"18-29"	"Had a heart attack and was gasping for air"
	"1783607-1"	"1783607-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"On August 27, 2021,  was he found deceased in his bed.  An autopsy was performed by the medical examiner's office.   Patients' sister reported that the night before he went to bed and was behaving normally. On Saturday, August 28th, the medical examiner called and informed us that his heart was enlarged. No previous history of enlarged heart had ever been reported and no heart issues had ever been considered in his past."
	"1783607-1"	"1783607-1"	"CARDIOMEGALY"	"10007632"	"18-29 years"	"18-29"	"On August 27, 2021,  was he found deceased in his bed.  An autopsy was performed by the medical examiner's office.   Patients' sister reported that the night before he went to bed and was behaving normally. On Saturday, August 28th, the medical examiner called and informed us that his heart was enlarged. No previous history of enlarged heart had ever been reported and no heart issues had ever been considered in his past."
	"1783607-1"	"1783607-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"On August 27, 2021,  was he found deceased in his bed.  An autopsy was performed by the medical examiner's office.   Patients' sister reported that the night before he went to bed and was behaving normally. On Saturday, August 28th, the medical examiner called and informed us that his heart was enlarged. No previous history of enlarged heart had ever been reported and no heart issues had ever been considered in his past."
	"1784945-1"	"1784945-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Blood in airway,  Death"
	"1784945-1"	"1784945-1"	"RESPIRATORY TRACT HAEMORRHAGE"	"10038727"	"6-17 years"	"6-17"	"Blood in airway,  Death"
	"1793706-1"	"1793706-1"	"ACUTE MYELOID LEUKAEMIA"	"10000880"	"18-29 years"	"18-29"	"On 8/12 patient developed nose bleed and was admitted to hospital  Bone marrow bx showed acute myeloid leukemia.  Chemo therapy started.  Patient became septic on 10/9 with hypotension and was intubated.  She coded on 10/10 and expired."
	"1793706-1"	"1793706-1"	"BIOPSY BONE MARROW ABNORMAL"	"10004738"	"18-29 years"	"18-29"	"On 8/12 patient developed nose bleed and was admitted to hospital  Bone marrow bx showed acute myeloid leukemia.  Chemo therapy started.  Patient became septic on 10/9 with hypotension and was intubated.  She coded on 10/10 and expired."
	"1793706-1"	"1793706-1"	"CHEMOTHERAPY"	"10061758"	"18-29 years"	"18-29"	"On 8/12 patient developed nose bleed and was admitted to hospital  Bone marrow bx showed acute myeloid leukemia.  Chemo therapy started.  Patient became septic on 10/9 with hypotension and was intubated.  She coded on 10/10 and expired."
	"1793706-1"	"1793706-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"On 8/12 patient developed nose bleed and was admitted to hospital  Bone marrow bx showed acute myeloid leukemia.  Chemo therapy started.  Patient became septic on 10/9 with hypotension and was intubated.  She coded on 10/10 and expired."
	"1793706-1"	"1793706-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"On 8/12 patient developed nose bleed and was admitted to hospital  Bone marrow bx showed acute myeloid leukemia.  Chemo therapy started.  Patient became septic on 10/9 with hypotension and was intubated.  She coded on 10/10 and expired."
	"1793706-1"	"1793706-1"	"EPISTAXIS"	"10015090"	"18-29 years"	"18-29"	"On 8/12 patient developed nose bleed and was admitted to hospital  Bone marrow bx showed acute myeloid leukemia.  Chemo therapy started.  Patient became septic on 10/9 with hypotension and was intubated.  She coded on 10/10 and expired."
	"1793706-1"	"1793706-1"	"HYPOTENSION"	"10021097"	"18-29 years"	"18-29"	"On 8/12 patient developed nose bleed and was admitted to hospital  Bone marrow bx showed acute myeloid leukemia.  Chemo therapy started.  Patient became septic on 10/9 with hypotension and was intubated.  She coded on 10/10 and expired."
	"1793706-1"	"1793706-1"	"SEPSIS"	"10040047"	"18-29 years"	"18-29"	"On 8/12 patient developed nose bleed and was admitted to hospital  Bone marrow bx showed acute myeloid leukemia.  Chemo therapy started.  Patient became septic on 10/9 with hypotension and was intubated.  She coded on 10/10 and expired."
	"1804633-1"	"1804633-1"	"AUTOPSY"	"10050117"	"18-29 years"	"18-29"	"Was not feeling well one month after vaccine. Had chest pains beginning in July of 2021. Did not go to doctor. Died suddenly on July 11th . It will be 6-9 months for autopsy results. Appeared to be sudden heart attack."
	"1804633-1"	"1804633-1"	"CHEST PAIN"	"10008479"	"18-29 years"	"18-29"	"Was not feeling well one month after vaccine. Had chest pains beginning in July of 2021. Did not go to doctor. Died suddenly on July 11th . It will be 6-9 months for autopsy results. Appeared to be sudden heart attack."
	"1804633-1"	"1804633-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"Was not feeling well one month after vaccine. Had chest pains beginning in July of 2021. Did not go to doctor. Died suddenly on July 11th . It will be 6-9 months for autopsy results. Appeared to be sudden heart attack."
	"1804633-1"	"1804633-1"	"MYOCARDIAL INFARCTION"	"10028596"	"18-29 years"	"18-29"	"Was not feeling well one month after vaccine. Had chest pains beginning in July of 2021. Did not go to doctor. Died suddenly on July 11th . It will be 6-9 months for autopsy results. Appeared to be sudden heart attack."
	"1804633-1"	"1804633-1"	"SUDDEN DEATH"	"10042434"	"18-29 years"	"18-29"	"Was not feeling well one month after vaccine. Had chest pains beginning in July of 2021. Did not go to doctor. Died suddenly on July 11th . It will be 6-9 months for autopsy results. Appeared to be sudden heart attack."
	"1804644-1"	"1804644-1"	"ACUTE RESPIRATORY DISTRESS SYNDROME"	"10001052"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"BLOOD CULTURE"	"10005485"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"CHILLS"	"10008531"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"COVID-19"	"10084268"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"COVID-19 PNEUMONIA"	"10084380"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"DYSPNOEA"	"10013968"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"HYPOPERFUSION"	"10058558"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"HYPOTENSION"	"10021097"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"HYPOXIA"	"10021143"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"INTENSIVE CARE"	"10022519"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"LACTIC ACIDOSIS"	"10023676"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"LUNG DISORDER"	"10025082"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"LUNG OPACITY"	"10081792"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"MECHANICAL VENTILATION"	"10067221"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"MYALGIA"	"10028411"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"OXYGEN SATURATION ABNORMAL"	"10033317"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"PARALYSIS"	"10033799"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"PNEUMOCYSTIS JIROVECII PNEUMONIA"	"10073755"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"PYREXIA"	"10037660"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"RESPIRATORY FAILURE"	"10038695"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"SEPSIS"	"10040047"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"SUBCUTANEOUS EMPHYSEMA"	"10042344"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"SUPERINFECTION"	"10042566"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1804644-1"	"1804644-1"	"TRAUMATIC LUNG INJURY"	"10069363"	"18-29 years"	"18-29"	"Hospital Course:  27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS.    Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability).    While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital.    On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned.    HOSPITAL COURSE 9/24 - 9/27   #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management.    #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus.  He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital."
	"1807886-1"	"1807886-1"	"ANGIOGRAM CEREBRAL ABNORMAL"	"10052906"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"BRAIN DEATH"	"10049054"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"DIZZINESS"	"10013573"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"HEADACHE"	"10019211"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"NAUSEA"	"10028813"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"SEIZURE"	"10039906"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"SUBARACHNOID HAEMORRHAGE"	"10042316"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"SUPERIOR SAGITTAL SINUS THROMBOSIS"	"10042567"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"URINARY TRACT INFECTION"	"10046571"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"VERTIGO"	"10047340"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"VISION BLURRED"	"10047513"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1807886-1"	"1807886-1"	"VOMITING"	"10047700"	"18-29 years"	"18-29"	"Patient started with headache, dizziness, blurred vision, nausea and vomiting which she went to an urgent care facility on 10/18.   On 10/19 she presented to an outside ER for the same symptoms, had a negative head CT and was sent home with antibiotics for a suspected UTI and meclizine for suspected vertigo.   On 10/20 she returned to that same ER with no improvement in symptoms, she experienced a seizure in their ER and Head CTa showed near complete thrombosis of superior sagittal sinus, with acute parasagittal frontal parenchymal and subarachnoid hemorrhage.   Patient arrived at our facility."
	"1814760-1"	"1814760-1"	"ARTERIOGRAM CORONARY ABNORMAL"	"10003201"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1814760-1"	"1814760-1"	"BRAIN NATRIURETIC PEPTIDE INCREASED"	"10053405"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1814760-1"	"1814760-1"	"CARDIOMEGALY"	"10007632"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1814760-1"	"1814760-1"	"CORONARY ARTERY THROMBOSIS"	"10011091"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1814760-1"	"1814760-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1814760-1"	"1814760-1"	"ELECTROCARDIOGRAM ST SEGMENT ELEVATION"	"10014392"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1814760-1"	"1814760-1"	"FIBRIN D DIMER"	"10016577"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1814760-1"	"1814760-1"	"MYOCARDIAL INFARCTION"	"10028596"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1814760-1"	"1814760-1"	"TROPONIN"	"10061576"	"18-29 years"	"18-29"	"Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded.  Patient expired during angiogram procedure"
	"1815096-1"	"1815096-1"	"ALANINE AMINOTRANSFERASE NORMAL"	"10001552"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"ANION GAP INCREASED"	"10002528"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"ASPARTATE AMINOTRANSFERASE INCREASED"	"10003481"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD ALBUMIN DECREASED"	"10005287"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD ALKALINE PHOSPHATASE NORMAL"	"10005310"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD BILIRUBIN NORMAL"	"10005367"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD CHLORIDE NORMAL"	"10005421"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD CREATININE NORMAL"	"10005484"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD POTASSIUM DECREASED"	"10005724"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD SODIUM NORMAL"	"10005804"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"BLOOD UREA NORMAL"	"10005857"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"CARBON DIOXIDE DECREASED"	"10007223"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"CARDIOVERSION"	"10007661"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"DIZZINESS"	"10013573"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"DYSPNOEA"	"10013968"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"FEELING ABNORMAL"	"10016322"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"FULL BLOOD COUNT"	"10017411"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"HAEMATOCRIT NORMAL"	"10018842"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"HAEMOGLOBIN NORMAL"	"10018890"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"METABOLIC FUNCTION TEST"	"10062191"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"NAUSEA"	"10028813"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"PLATELET COUNT NORMAL"	"10035530"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"RESUSCITATION"	"10038749"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"SUPRAVENTRICULAR TACHYCARDIA"	"10042604"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"VOMITING"	"10047700"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815096-1"	"1815096-1"	"WHITE BLOOD CELL COUNT NORMAL"	"10047944"	"6-17 years"	"6-17"	""Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness.  At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness.  EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was ""in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%.""  In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.""
	"1815295-1"	"1815295-1"	"AUTOPSY"	"10050117"	"6-17 years"	"6-17"	"Acute Hyperglycemic Crisis"
	"1815295-1"	"1815295-1"	"HYPERGLYCAEMIA"	"10020635"	"6-17 years"	"6-17"	"Acute Hyperglycemic Crisis"
	"1828901-1"	"1828901-1"	"ANGIOGRAM PULMONARY NORMAL"	"10002442"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"C-REACTIVE PROTEIN INCREASED"	"10006825"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"CARDIAC ARREST"	"10007515"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"CARDIOVERSION"	"10007661"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"CHEST DISCOMFORT"	"10008469"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"CHEST PAIN"	"10008479"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"CONDITION AGGRAVATED"	"10010264"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"COVID-19"	"10084268"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"DYSPNOEA"	"10013968"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"EJECTION FRACTION DECREASED"	"10050528"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"ELECTROCARDIOGRAM ST SEGMENT ELEVATION"	"10014392"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"FULL BLOOD COUNT"	"10017411"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION"	"10081572"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"LIFE SUPPORT"	"10024447"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"MALAISE"	"10025482"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"METABOLIC FUNCTION TEST"	"10062191"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"RESUSCITATION"	"10038749"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"TACHYCARDIA"	"10043071"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"TROPONIN INCREASED"	"10058267"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1828901-1"	"1828901-1"	"VENTRICULAR ARRHYTHMIA"	"10047281"	"6-17 years"	"6-17"	"Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully.  She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21.  She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h.  Was feeling completely well prior to onset of chest discomfort.  Symptoms were mild.  No sick contacts or family members.  ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure.  EKG with diffuse ST elevation.  Troponin elevated at 20.  CTA chest negative for PE or pneumonia.  SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination.  Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors.  STAT Echo resulted depressed EF 40-45%.  Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic.  Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest.  Initial rhythm was VT.  Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics.  Unfortunately she was not able to be resuscitated and died.  Cause of death possible acute myocarditis."
	"1831721-1"	"1831721-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Blood clot induced death."
	"1831721-1"	"1831721-1"	"DEEP VEIN THROMBOSIS"	"10051055"	"18-29 years"	"18-29"	"Blood clot induced death."
	"1831721-1"	"1831721-1"	"INTRACARDIAC THROMBUS"	"10048620"	"18-29 years"	"18-29"	"Blood clot induced death."
	"1831721-1"	"1831721-1"	"PULMONARY EMBOLISM"	"10037377"	"18-29 years"	"18-29"	"Blood clot induced death."
	"1831721-1"	"1831721-1"	"SUDDEN DEATH"	"10042434"	"18-29 years"	"18-29"	"Blood clot induced death."
	"1831721-1"	"1831721-1"	"SUPERFICIAL VEIN THROMBOSIS"	"10086210"	"18-29 years"	"18-29"	"Blood clot induced death."
	"1831721-1"	"1831721-1"	"THROMBOSIS"	"10043607"	"18-29 years"	"18-29"	"Blood clot induced death."
	"1833098-1"	"1833098-1"	"ACTIVATED PARTIAL THROMBOPLASTIN TIME PROLONGED"	"10000636"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"ALANINE AMINOTRANSFERASE INCREASED"	"10001551"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"ANION GAP INCREASED"	"10002528"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"ASPARTATE AMINOTRANSFERASE INCREASED"	"10003481"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD ALBUMIN NORMAL"	"10005289"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD ALKALINE PHOSPHATASE NORMAL"	"10005310"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD BICARBONATE DECREASED"	"10005359"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD BILIRUBIN NORMAL"	"10005367"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD CALCIUM DECREASED"	"10005395"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD CHLORIDE NORMAL"	"10005421"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD CREATINE PHOSPHOKINASE NORMAL"	"10005479"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD CREATININE INCREASED"	"10005483"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD GLUCOSE NORMAL"	"10005558"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD LACTIC ACID"	"10005632"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD MAGNESIUM INCREASED"	"10005655"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD OSMOLARITY NORMAL"	"10005698"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD PH DECREASED"	"10005706"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD PHOSPHORUS INCREASED"	"10050196"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD POTASSIUM NORMAL"	"10005726"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD SODIUM NORMAL"	"10005804"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"BLOOD UREA NORMAL"	"10005857"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"HAEMATOCRIT NORMAL"	"10018842"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"LABORATORY TEST"	"10059938"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"MEAN CELL HAEMOGLOBIN CONCENTRATION DECREASED"	"10026991"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"MEAN CELL HAEMOGLOBIN NORMAL"	"10026997"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"MEAN CELL VOLUME INCREASED"	"10027004"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"N-TERMINAL PROHORMONE BRAIN NATRIURETIC PEPTIDE INCREASED"	"10071662"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"PCO2 INCREASED"	"10034183"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"PLATELET COUNT NORMAL"	"10035530"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"PO2 INCREASED"	"10035769"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"PROTEIN TOTAL DECREASED"	"10037014"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"RED BLOOD CELL COUNT DECREASED"	"10038153"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"TROPONIN I INCREASED"	"10058268"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1833098-1"	"1833098-1"	"WHITE BLOOD CELL COUNT NORMAL"	"10047944"	"18-29 years"	"18-29"	"According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on  08/09/2021."
	"1839201-1"	"1839201-1"	"CARDIAC ARREST"	"10007515"	"18-29 years"	"18-29"	"Cardiac arrest; This is a spontaneous report from a contactable physician. A 28-year-old female patient received the third dose of BNT162B2 at 28-year-old, intramuscularly on 01Oct2021 (Batch/Lot Number: EW0168) at single dose (booster) for COVID-19 immunisation. Medical history was none. No known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. Concomitant medication included ethinylestradiol/ferrous fumarate/norethisterone (NORETHINDRONE AND ETHINYL ESTRADIOL AND FERROUS FUMARATE). Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient previously received the first dose of BNT162B2, intramuscularly on 03Jan2021 (lot number: EL0142) at 27-year-old, and the second dose intramuscularly on 23Jan2021 (lot number: EL9262) at 27-year-old for COVID-19 immunisation. The patient experienced cardiac arrest on 15Oct2021. Unwitnessed at home. When found, patient passed away already without any signs of calling 911 or rescue. No treatment received. Since the vaccination, the patient had not been tested for COVID-19. The patient died on 15Oct2021. An autopsy was performed and results were not provided.; Reported Cause(s) of Death: Cardiac arrest"
	"1846958-1"	"1846958-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"18-29 years"	"18-29"	"heart attack, blood clots, stroke"
	"1846958-1"	"1846958-1"	"MYOCARDIAL INFARCTION"	"10028596"	"18-29 years"	"18-29"	"heart attack, blood clots, stroke"
	"1846958-1"	"1846958-1"	"THROMBOSIS"	"10043607"	"18-29 years"	"18-29"	"heart attack, blood clots, stroke"
	"1853429-1"	"1853429-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death- after vaccine patient was ill with dizziness and lethargia. Patient went to bed at 8pm that night. Patient was found deceased the next day when housemate went to wake him up. Patient had no prior history of underlying health complications. Cause of death ruled to be sudden unexpected heart attack."
	"1853429-1"	"1853429-1"	"DIZZINESS"	"10013573"	"18-29 years"	"18-29"	"Death- after vaccine patient was ill with dizziness and lethargia. Patient went to bed at 8pm that night. Patient was found deceased the next day when housemate went to wake him up. Patient had no prior history of underlying health complications. Cause of death ruled to be sudden unexpected heart attack."
	"1853429-1"	"1853429-1"	"LETHARGY"	"10024264"	"18-29 years"	"18-29"	"Death- after vaccine patient was ill with dizziness and lethargia. Patient went to bed at 8pm that night. Patient was found deceased the next day when housemate went to wake him up. Patient had no prior history of underlying health complications. Cause of death ruled to be sudden unexpected heart attack."
	"1853429-1"	"1853429-1"	"MALAISE"	"10025482"	"18-29 years"	"18-29"	"Death- after vaccine patient was ill with dizziness and lethargia. Patient went to bed at 8pm that night. Patient was found deceased the next day when housemate went to wake him up. Patient had no prior history of underlying health complications. Cause of death ruled to be sudden unexpected heart attack."
	"1853429-1"	"1853429-1"	"MYOCARDIAL INFARCTION"	"10028596"	"18-29 years"	"18-29"	"Death- after vaccine patient was ill with dizziness and lethargia. Patient went to bed at 8pm that night. Patient was found deceased the next day when housemate went to wake him up. Patient had no prior history of underlying health complications. Cause of death ruled to be sudden unexpected heart attack."
	"1854668-1"	"1854668-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Was very tired and had sore muscles on September 09. Found September 10, 5:25 am dead. There were excessive amounts of blood along with large blood clots that appear to have come vaginally."
	"1854668-1"	"1854668-1"	"FATIGUE"	"10016256"	"6-17 years"	"6-17"	"Was very tired and had sore muscles on September 09. Found September 10, 5:25 am dead. There were excessive amounts of blood along with large blood clots that appear to have come vaginally."
	"1854668-1"	"1854668-1"	"MYALGIA"	"10028411"	"6-17 years"	"6-17"	"Was very tired and had sore muscles on September 09. Found September 10, 5:25 am dead. There were excessive amounts of blood along with large blood clots that appear to have come vaginally."
	"1854668-1"	"1854668-1"	"THROMBOSIS"	"10043607"	"6-17 years"	"6-17"	"Was very tired and had sore muscles on September 09. Found September 10, 5:25 am dead. There were excessive amounts of blood along with large blood clots that appear to have come vaginally."
	"1865279-1"	"1865279-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death."
	"1868972-1"	"1868972-1"	"ILLNESS"	"10080284"	"18-29 years"	"18-29"	"Severe Illness"
	"1890705-1"	"1890705-1"	"BLOOD GASES ABNORMAL"	"10005539"	"3-5 years"	"3-5"	"Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine.  Patient was moved from PICU to general peds floor due to improvement in condition on Thursday.  Vaccine was administered that evening.  Patient did well.  Remained on room air.  Was discharged home on Saturday.  On Monday morning, father checked on patient and she was found pulseless and not breathing.  It is unclear whether or not patient was placed on home CPAP during the night.  EMS called.  Patient arrived to ED as a CPR in progress.  Patient presented with a pH of <6.  Last known well 9pm the evening prior.  Patient expired at  11/22/21 at 11:05 CST."
	"1890705-1"	"1890705-1"	"BLOOD PH DECREASED"	"10005706"	"3-5 years"	"3-5"	"Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine.  Patient was moved from PICU to general peds floor due to improvement in condition on Thursday.  Vaccine was administered that evening.  Patient did well.  Remained on room air.  Was discharged home on Saturday.  On Monday morning, father checked on patient and she was found pulseless and not breathing.  It is unclear whether or not patient was placed on home CPAP during the night.  EMS called.  Patient arrived to ED as a CPR in progress.  Patient presented with a pH of <6.  Last known well 9pm the evening prior.  Patient expired at  11/22/21 at 11:05 CST."
	"1890705-1"	"1890705-1"	"CARBON DIOXIDE INCREASED"	"10007225"	"3-5 years"	"3-5"	"Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine.  Patient was moved from PICU to general peds floor due to improvement in condition on Thursday.  Vaccine was administered that evening.  Patient did well.  Remained on room air.  Was discharged home on Saturday.  On Monday morning, father checked on patient and she was found pulseless and not breathing.  It is unclear whether or not patient was placed on home CPAP during the night.  EMS called.  Patient arrived to ED as a CPR in progress.  Patient presented with a pH of <6.  Last known well 9pm the evening prior.  Patient expired at  11/22/21 at 11:05 CST."
	"1890705-1"	"1890705-1"	"DEATH"	"10011906"	"3-5 years"	"3-5"	"Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine.  Patient was moved from PICU to general peds floor due to improvement in condition on Thursday.  Vaccine was administered that evening.  Patient did well.  Remained on room air.  Was discharged home on Saturday.  On Monday morning, father checked on patient and she was found pulseless and not breathing.  It is unclear whether or not patient was placed on home CPAP during the night.  EMS called.  Patient arrived to ED as a CPR in progress.  Patient presented with a pH of <6.  Last known well 9pm the evening prior.  Patient expired at  11/22/21 at 11:05 CST."
	"1890705-1"	"1890705-1"	"INTENSIVE CARE"	"10022519"	"3-5 years"	"3-5"	"Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine.  Patient was moved from PICU to general peds floor due to improvement in condition on Thursday.  Vaccine was administered that evening.  Patient did well.  Remained on room air.  Was discharged home on Saturday.  On Monday morning, father checked on patient and she was found pulseless and not breathing.  It is unclear whether or not patient was placed on home CPAP during the night.  EMS called.  Patient arrived to ED as a CPR in progress.  Patient presented with a pH of <6.  Last known well 9pm the evening prior.  Patient expired at  11/22/21 at 11:05 CST."
	"1890705-1"	"1890705-1"	"PULSE ABSENT"	"10037469"	"3-5 years"	"3-5"	"Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine.  Patient was moved from PICU to general peds floor due to improvement in condition on Thursday.  Vaccine was administered that evening.  Patient did well.  Remained on room air.  Was discharged home on Saturday.  On Monday morning, father checked on patient and she was found pulseless and not breathing.  It is unclear whether or not patient was placed on home CPAP during the night.  EMS called.  Patient arrived to ED as a CPR in progress.  Patient presented with a pH of <6.  Last known well 9pm the evening prior.  Patient expired at  11/22/21 at 11:05 CST."
	"1890705-1"	"1890705-1"	"RESPIRATORY ARREST"	"10038669"	"3-5 years"	"3-5"	"Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine.  Patient was moved from PICU to general peds floor due to improvement in condition on Thursday.  Vaccine was administered that evening.  Patient did well.  Remained on room air.  Was discharged home on Saturday.  On Monday morning, father checked on patient and she was found pulseless and not breathing.  It is unclear whether or not patient was placed on home CPAP during the night.  EMS called.  Patient arrived to ED as a CPR in progress.  Patient presented with a pH of <6.  Last known well 9pm the evening prior.  Patient expired at  11/22/21 at 11:05 CST."
	"1890705-1"	"1890705-1"	"RESUSCITATION"	"10038749"	"3-5 years"	"3-5"	"Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine.  Patient was moved from PICU to general peds floor due to improvement in condition on Thursday.  Vaccine was administered that evening.  Patient did well.  Remained on room air.  Was discharged home on Saturday.  On Monday morning, father checked on patient and she was found pulseless and not breathing.  It is unclear whether or not patient was placed on home CPAP during the night.  EMS called.  Patient arrived to ED as a CPR in progress.  Patient presented with a pH of <6.  Last known well 9pm the evening prior.  Patient expired at  11/22/21 at 11:05 CST."
	"1912785-1"	"1912785-1"	"CARDIAC ARREST"	"10007515"	"6-17 years"	"6-17"	"Dose 1 given 4/21/2021 Pfizer Lot # EW0172  Patient had a cardiac arrest at home and was pronounced dead at Emergency Room. Covid test was negative."
	"1912785-1"	"1912785-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Dose 1 given 4/21/2021 Pfizer Lot # EW0172  Patient had a cardiac arrest at home and was pronounced dead at Emergency Room. Covid test was negative."
	"1912785-1"	"1912785-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"6-17 years"	"6-17"	"Dose 1 given 4/21/2021 Pfizer Lot # EW0172  Patient had a cardiac arrest at home and was pronounced dead at Emergency Room. Covid test was negative."
	"1913198-1"	"1913198-1"	"ACUTE KIDNEY INJURY"	"10069339"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"AIRWAY PEAK PRESSURE INCREASED"	"10068853"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"ASTHENIA"	"10003549"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"BACK PAIN"	"10003988"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"BRADYCARDIA"	"10006093"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"CARDIAC OUTPUT DECREASED"	"10007595"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"CARDIAC TAMPONADE"	"10007610"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"CHEMOTHERAPY"	"10061758"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"CHEST PAIN"	"10008479"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"DEATH"	"10011906"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"DEBRIDEMENT"	"10067806"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"DIARRHOEA"	"10012735"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"DYSPNOEA"	"10013968"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"EPITHELIOID SARCOMA"	"10015099"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"EXPLORATORY OPERATION"	"10056589"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"FATIGUE"	"10016256"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"FLUID RETENTION"	"10016807"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"GENERAL SYMPTOM"	"10060891"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"HAEMOFILTRATION"	"10053090"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"HYPOTENSION"	"10021097"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"INFLUENZA VIRUS TEST NEGATIVE"	"10070718"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"INTRACARDIAC MASS"	"10066087"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"LACTIC ACIDOSIS"	"10023676"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES"	"10079487"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"LOW LUNG COMPLIANCE"	"10086117"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"NEOPLASM MALIGNANT"	"10028997"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"OEDEMA"	"10030095"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"OROPHARYNGEAL PAIN"	"10068319"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"PERICARDIAL EXCISION"	"10034475"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"PERICARDIAL RUB"	"10049759"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"PNEUMONIA"	"10035664"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"PULMONARY OEDEMA"	"10037423"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"PYREXIA"	"10037660"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"SEDATION"	"10039897"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"STREPTOCOCCUS TEST NEGATIVE"	"10070415"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"TACHYCARDIA"	"10043071"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1913198-1"	"1913198-1"	"TUMOUR EXCISION"	"10061392"	"6-17 years"	"6-17"	"Patient received Pfizer vaccine in 8/2021. In 9/2021 she began to have some vague complaints of upper back pain. Patient ultimately diagnosed with epitheliod sarcoma. Parents requested that this information be sent to VAERS in case her cancer was related to Vaccine. Physicians caring for the child do not feel her death or her cancer was related to the covid vaccine. Presented to the local Medical Center on 10/30/21 after having received care closer to home. Pt is a 13 y.o. female with no past medical history who presents with fever, chest pain, and diarrhea. About two weeks PTA, she began complaining of sternal chest pain. She had fatigue and sore throat so was taken to an urgent care where she was negative for strep, flu, and COVID. She was prescribed bromfed. She then progressed to a dry mild that started about 10 days PTA. On Tuesday, 10/26, she was seen at an outside ER and was diagnosed with pneumonia. She was started on azithromycin and augmentin. She has continued to have chest pain, SOB, and fatigue. The day of presentation, she stayed home from school. She developed nonbloody diarrhea, tachycardia, and weakness so she was taken back to the ER for evaluation. Found to have a pericardial friction rub. Admitted to hospitalist service."
	"1919213-1"	"1919213-1"	"ACUTE HEPATIC FAILURE"	"10000804"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"ACUTE LEFT VENTRICULAR FAILURE"	"10063081"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"ANGIOGRAM CEREBRAL"	"10052905"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"ANGIOGRAM CEREBRAL ABNORMAL"	"10052906"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"BRAIN DEATH"	"10049054"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"BRAIN HERNIATION"	"10006126"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"BRAIN OEDEMA"	"10048962"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"CARDIAC FAILURE"	"10007554"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"CARDIOGENIC SHOCK"	"10007625"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"COMPUTERISED TOMOGRAM HEAD"	"10054003"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"DEATH"	"10011906"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"DISTRIBUTIVE SHOCK"	"10070559"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"ECHOCARDIOGRAM"	"10014113"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"GASTROINTESTINAL HAEMORRHAGE"	"10017955"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"HAEMATEMESIS"	"10018830"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"HYPERAMMONAEMIA"	"10020575"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"HYPERVENTILATION"	"10020910"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"INTENSIVE CARE"	"10022519"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"INTRACRANIAL PRESSURE INCREASED"	"10022773"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"LABORATORY TEST"	"10059938"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"LACTIC ACIDOSIS"	"10023676"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"MENTAL STATUS CHANGES"	"10048294"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"PUPIL FIXED"	"10037515"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
	"1919213-1"	"1919213-1"	"RESPIRATORY DISTRESS"	"10038687"	"18-29 years"	"18-29"	"Death; Angiogram cerebral abnormal; Computerised tomogram head abnormal; Echocardiogram abnormal; Laboratory test; Multiple organ dysfunction syndrome; Acute hepatic failure; Acute left ventricular failure; Brain death; Brain oedema; Brain herniation; Cardiogenic shock; Cardiac failure; Pupil fixed; Distributive shock; Respiratory distress; Lactic acidosis; Intracranial pressure increased; Gastrointestinal haemorrhage; Haematemesis; Hyperammonaemia; Endotracheal intubation; Hyperventilation; Intensive care; Mental status changes; This spontaneous report received from a health care professional via a Regulatory Authority VAERS (Vaccine Adverse Event Reporting System) (VAERS ID: 1582506) and from a medical examiner concerned a 24 year old female. The patient's height, and weight were not reported. The patient's past medical history included: C-section (cesarean section), and post partum (27-FEB-2021). The patient had no allergies to medication, food or other products. The patient had no chronic or long-standing health conditions and was not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 207A21A and expiry: unknown) dose was not reported, 1 total, administered on 09-JUL-2021 to left arm for prophylactic vaccination. Concomitant medications included ferrous sulfate for unknown indication.  On 15-JUL-2021, (as reported after getting vaccinated) the patient was admitted to a local hospital and then transferred to another hospital and was finally transferred to a final medical center intensive care unit (ICU). She was admitted as a transfer from a Health Care Facilities (HCF) with acute liver failure of unknown etiology and without hepatic coma. On arrival, she had altered mental status with respiratory distress and coffee ground emesis (haematemesis). She was promptly intubated (endotracheal intubation) for airway protection. A gastrointestinal (GI) bleed (gastrointestinal haemorrhage) was suspected thus she was started on octreotide and Protonix (pantoprazole sodium) and intravenous (IV) ceftriaxone. An a-line dialysis line and an orogastric tube was placed and there was no acute GI bleeding thereafter.  Laboratory tests demonstrated severe lactic acidosis, severe hyperammonemia, and acute renal failure. Thus, Continuous Veno-Venous Hemofiltration (CVVH) was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory (distributive shock) and cardiogenic shock. She had multiple organ dysfunction syndrome. Cardiac echo demonstrated acute systolic and diastolic heart failure (acute left ventricular failure and cardiac failure) with reduced ejection fraction (EF). However, no intervention was recommended by cardiology due to multiorgan failure. Computerized tomography (CT) brain on 15-JUL-2021, demonstrated diffuse brain edema (brain oedema) and mild cerebellar tonsillar herniation (brain herniation). Neurosurgery was consulted and bolt placement was performed. Increased intracranial pressures (ICPs) were consistently elevated greater than 100s. Repeat Computerized tomography (CT) brain demonstrated worsening cerebral edema (brain oedema) and herniation. By the evening of 15-JUL-2021 her pupillary exam became fixed (pupil fixed) and dilated despite being on maximum pentobarbital therapy and propofol. To decrease intracranial pressure (ICP) head of bed was at 45 degrees plus. All times mannitol and mild hyperventilation was given for cerebral edema and elevated intracranial pressure (ICPs). Once CVVH was initiated though mannitol and hypertonic saline were not treatment options as the continuous Veno-Venous Hemofiltration (CVVH) cleared the medication quickly. The patient was listed for orthotopic liver transplantation (OLT) that afternoon, but later determined not to be a candidate due to her worsening neurological status. She had a change in pupil examination, which was suggestive of worsened herniation. Her pupils became fixed dilated and CT confirmed worsening herniation. ICPs remained 120 plus despite triple pressure support in effort to maintain Cerebral perfusion pressure (CPP). A diagnostic cerebral angiogram was performed on 16-JUL-2021, due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family the patient became do not resuscitate (DNR). The family elected to discontinue supportive measures on 18-JUL-2021, and the patient was pronounced dead at 09:22.  It was reported that the patient had not recovered from the adverse events at the time of death. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to multiple organ dysfunction syndrome, acute hepatic failure, acute left ventricular failure, brain death, brain oedema, brain herniation, cardiogenic shock, cardiac failure, pupil fixed, distributive shock, respiratory distress, lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal and laboratory test on 18-JUL-2021. The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.  This report was serious (Death).  Additional information was received from a medical examiner on 29-NOV-2021. The following information was updated and incorporated into the case narrative: The cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death.; Sender's Comments: V4: Additional information received updates the cause of death on the death certificate was mentioned as cerebellar tonsillar herniation, acute liver failure, multi-organ failure and the manner of death was natural death. This updated information does not alter prior causality assessment of reported events. 20210857040-Covid-19 vaccine ad26.cov2.s -Death, Multiple organ dysfunction syndrome, Acute hepatic failure, acute left ventricular failure, Brain death, brain oedema, Brain herniation, cardiogenic shock, Cardiac failure, pupil fixed, Distributive shock, respiratory distress, Lactic acidosis, intracranial pressure increased, gastrointestinal haemorrhage, haematemesis, , hyperammonaemia, endotracheal intubation, hyperventilation, intensive care, mental status changes, angiogram cerebral abnormal, computerised tomogram head abnormal, echocardiogram abnormal, laboratory test. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CEREBELLAR TONSILLAR HERNIATION; ACUTE LIVER FAILURE; MULTI-ORGAN FAILURE; NATURAL DEATH"
"---"
"Dataset: The Vaccine Adverse Event Reporting System (VAERS)"
"Query Parameters:"
"Title: 211214 CDC covid VAERS report - all reports.txt"
"Age: < 6 months; 6-11 months; 1-2 years; 3-5 years; 6-17 years; 18-29 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: The United States/Territories/Unknown"
"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 3:32:20 PM"
"---"
"Suggested Citation: Accessed at http://wonder.cdc.gov/vaers.html on Dec 14, 2021 3:32:20 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 148 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>"