VAERS 2536088
SANOFI PASTEUR · INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) · Charge ut7682la
- Staat
- IN
- Alter
- 57,0
- Geschlecht
- F
- Eingang
- 17.12.2022
- Impfdatum
- 30.09.2022
- Beginn
- 15.12.2022
- Tage bis Beginn
- 76,0
- Dosis
- UNK
- Route/Site
- SYR / -
Symptomtext
Document Type: History and Physical Document Subject: History & Physical Note Performed By: MD on December 15, 2022 17:24 Verified By: MD on December 15, 2022 17:24 Encounter Info: Inpatient, 12/15/22 - * Final Report * History of Present Illness/Subjective 57 year old female with Hx of COPD, OSA on CPAP and GERD presents to the ED via EMS c/o increased SOB and fevers onset 4 days ago. Patient reports to be apparently well until 4 days ago when she started noticing shortness of breath associated with cough productive of greenish sputum. 1 week prior to onset of shortness of breath patient had flu respiratory disease which is managed symptomatically and did not require to be in the hospital. Shortness of breath is associated with fever, cough, low urine volume, on and off chest pain and nausea. No vomiting, diarrhea, headache, constipation no recent travel history EMS gave breathing treatment, Solu-Medrol, en route. Pt denies tobacco or EtOH use. She states she has been around people with a cough. CODE STATUS-full code In the ER Vital signs In ED, pt's initial temperature was 40.2 C. Blood pressure 137/71, heart rate 95, respiratory rate 18, on 4 L of nasal cannula. She was noted to be in acute respiratory failure with increased work of breathing and has been on and off BiPAP throughout her hospital course in the ER. Labs WBC 19.1, hemoglobin 9.5, hematocrit 29.3, platelet 150, sodium 136, potassium 4.1, chloride 102, bicarb 23, BUN/creatinine 34/1.71, glucose 126 Troponin 4, lactate 0.7 Venous blood gas pH 7.36, PCO2 44, PO2 58, oxygen saturation 88 Urinalysis-WBC 11-20, moderate to high squamous epithelial cell Flu negative COVID-negative Imaging CT chest Multifocal airspace disease involving all lobes, including regions of frank consolidation involving both lower lobes, the lateral segment of the right middle lobe, and posterior left upper lobe as described above. Numerous smaller patchy foci of airspace disease as well. The appearance is nonspecific, with differential diagnosis including atypical infection and multifocal inflammatory lung disease. Borderline/mild mediastinal and supra clavicular adenopathy. No overt malignant findings. CXR Right hilar prominence with multiple bilateral nodular opacities may represent multifocal pneumonia but raises the possibility of metastatic malignancy Patient is admitted for acute respiratory failure secondary to multifocal pneumonia Review of Systems All 13 point review of systems were reviewed with the patient and are negative except as specified in the HPI Physical Exam/Objective Vital Signs (most recent and range for last 24 hours) Temp (CEL) 36.9 (36.9-36.9) Temp (FAHR) 98.4 (98.4-98.4), BP 149/77 (149-149)/(77-77), HR 95 (95-95), RR 18 (18-18), O2Sat 92 (92-92) Patient Weight Patient Height None Reported General: Alert and oriented, No acute distress. Eye: Normal conjunctiva. Cardiovascular: Regular rate, Normal rhythm, No murmur. Respiratory: Lungs are clear to auscultation, Respirations are non-labored. On 4 L of nasal cannula Gastrointestinal: Soft, Non-tender, Non-distended, Normal bowel sounds, No organomegaly. Neurologic: Alert, Oriented, non focal Psychiatric: Cooperative, Appropriate mood & affect. Musculoskeletal: No swelling, Assessment/Plan 57 year old female with Hx of COPD, OSA on CPAP and GERD presents to the ED via EMS c/o increased SOB and fevers onset 4 days ago 1. Pneumonia J18.9 Evidenced on chest imaging. Pneumonia is multifocal and given history of recent influenza infection, pneumonia is likely to be post influenza pneumonia which is usually caused by MRSA. We will give broad coverage antibiotics to include MRSA infection-cefepime and vancomycin -Send pneumonia labs -Continue oxygen supplementation to maintain SPO2 above 92% -Other respiratory protocol to continue -Get MRSA swab -Pharmacy to dose vancomycin 2. Sepsis A41.9 Meets SIRS criteria on admission with high-grade fever tachycardia, and leukocytosis. Lactate is normal so no severe sepsis. , imaging for multifocal infiltrate. Blood cultures pending, urinalysis appears weakly positive at this time URINE sample is dirty evidenced by squamous epithelium, procalcitonin pending, lactate repeat WNL. Continue empiric coverage with cefepime and vancomycin de-escalate therapy as appropriate. SARS CoV 2 negative. Continue IVF at 100cc/hr 3. Acute respiratory failure J96.00 Secondary to pneumonia Management as outlined in #1 4. Chronic kidney disease N18.9 Creatinine at baseline. Patient reports reduced urinary output, will monitor urinary output closely with IV hydration for response. Avoid nephrotoxic medications 5. Dependence on CPAP ventilation Z99.89 Due to OSA. Patient needs nightly CPAP for OSA To ensure continuation during hospitalization. 6. HTN (hypertension) I10 Chronic Continue home meds as blood pressure tolerates 7. Hyperlipidemia E78.5 Chronic Continue home meds 8. OSA on CPAP G47.33 Nocturnal CPAP to continue Orders: acetaminophen, 650 mg, Orally, Tablet, Q4H, PRN, Pain, Mild PO (1-3 out of 10)/Fever, 12/15/22 15:42:00 albuterol-ipratropium, 3 mL, Neb Inhal, Inhalation SOLN, Aerosol Treatment, Q6H, 12/15/22 19:00:00 cefePIME, 1 GM, IVPB, Injection, Q8H, Indication: Pneumonia - CAP (MRSA/PSA Risk Factors), 12/15/22 20:00:00, for 14 Doses, 12/20/22 4:00:00, 12.5 mL/hr, Infuse Over 4 Hours, Total Volume (mL) = 50 heparin, 7,500 Units, Subcutaneous, Injection, Q8, Routine, 12/15/22 22:00:00 ondansetron, 4 mg, IV Push, Injection, Q6H, PRN, Nausea/Vomiting IV - Use First, 12/15/22 15:42:00 polyethylene glycol 3350, 17 GM, Orally, Powder, Daily, PRN, Constipation - Use First, 12/15/22 15:42:00 Sodium Chloride 0.9% 1,000 mL, Total Volume (mL) = 1,000, IV, 12/15/22 15:42:00, 100 mL/hr, Clinical Weight Sodium Chloride 0.9% 500 mL, Total Volume (mL) = 500, IV, 12/15/22 16:40:00, Other - See Comments, Clinical Weight vancomycin, 1.5 GM = 15 mL, IVPB, Injection, Q18H, Indication: Pneumonia - CAP (MRSA/PSA Risk Factors), 12/15/22 21:00:00 180 gm Carb per day Diet Admit to Inpatient Call Blood Glucose Call Diastolic Blood Pressure Call Heart Rate Call Mental Status Changes Call O2 Saturation Call Respiratory Distress Call Respiratory Rate Call Systolic Blood Pressure Call Temperature CBC w/Differential Comp Metabolic Panel CPAP Intermittent DC SIRS Alert and Sepsis Screen Do Not (Specify) Hgb A1C HPLC Bld QN Incentive Spirometry Initiate IV Care Protocols As Appropriate Initiate Mobility Protocol Initiate Respiratory Protocol Initiate Skin and Wound Care Protocol L pneumophila Ag Ur QL Level of Care Lipid Panel SerPl QN Medical Service MRSA PCR Mucous Clearance Device Nasal Cannula OT Evaluation and Treatment Peripheral IV Insertion Procalcitonin Procalcitonin PT Evaluation and Treatment Resp CX + Stn Resp Evaluation or Assessment Resuscitation Status RVP2 PCR Strep pneumoniae Ag Urine Titrate FiO2 to Keep O2 Sat TSH w FreeT4 reflex Vancomycin Pharmacy Dosing Consult Vital Signs Vital Signs Weight Greater than 60 minutes total with greater than 50% of time face-to-face with patient reviewing course, plan of care, and in care coordination Code Status Resuscitation Status - Ordered -- 12/15/22 15:42:00, Full Code Chronic Problem List Addison's disease Anxiety Anxiety and depression Breast cancer screening Chronic UTI Constipation COPD (chronic obstructive pulmonary disease) Depression GERD (gastroesophageal reflux disease) History of bariatric surgical procedure. History of kidney stones HTN (hypertension) Hydronephrosis Hyperlipidemia Hypothyroidism Knee pain Leg cramps Lesion of bladder Medicare annual wellness visit, subsequent Morbid obesity Nausea OA (osteoarthritis) OA (osteoarthritis) of knee OSA on CPAP RA (rheumatoid arthritis) Super obesity Tachycardia Procedure/Surgical History ?cystoscopy with stent placement (10/20/2022) ?cystoscopy (08/2022) ?cysto, bladder biopsy, fulguration, bilat retrograde pyelogram (01/17/2022) ?Colonoscopy (10/17/2018) ?History of laparoscopic adjustable gastric banding ?Hysterectomy ?Left knee surgery ?Surgery ?Tonsillectomy and adenoidectomy Surgical History Internal 11/11/2022 Ureteroscopy. 10/20/2022 Cystoscopy Insert Ureteral Stent or Cath (Right) 01/17/2022 Cystoscopy Bladder Biopsy 10/17/2018 Colonscpy Diagnostic/Screen Medications Home Medications (29) Active acetaminophen 650 mg oral tablet, extended release 1,300 mg = 2 Tablet, PRN, Orally Aldactone 50 mg oral tablet 50 mg = 1 Tablet, Orally, Daily amitriptyline 25 mg oral tablet 25 mg = 1 Tablet, Orally, At Bedtime amLODIPine 10 mg oral tablet 10 mg = 1 Tablet, Orally, Daily carvedilol 25 mg oral tablet 25 mg = 1 Tablet, Orally, BID Centrum Silver Ultra Women's 1 Tablet, Orally, QAM Colace 100 mg oral capsule 100 mg = 1 Capsule, Orally, BID Combivent Respimat CFC free 100 mCg-20 mCg/inh inhalation aerosol 1 Puff, Inhalation, 4 Times Daily Order Details or printed requisition for more information., This is a print requisition order, cannot be ePrescribed. Dulera 200 mCg-5 mCg/inh inhalation aerosol 2 Puff, Inhalation, BID estradiol topical 0.1 mg/gm cream See Instructions, Apply pea sized amt to vaginal opening nightly x 2 weeks, then 2x/week thereafter. Fasenra 30 mg, Subcutaneous, Every 8 Weeks fluticasone 50 mCg/inh nasal spray 100 mCg = 2 Spray, intraNASAL, BID hydrALAZINE 50 mg oral tablet 100 mg = 2 Tablet, Orally, TID hydroCODONE-acetaminophen 10 mg-325 mg oral tablet 1 Tablet, PRN, Orally, Q6H hydrOXYzine hydrochloride 25 mg oral tablet 25 mg = 1 Tablet, PRN, Orally, Q6H leflunomide 20 mg oral tablet 20 mg = 1 Tablet, Orally, Daily levothyroxine 100 mCg (0.1 mg) oral tablet 100 mCg = 1 Tablet, Orally, QAM losartan 100 mg oral tablet 100 mg = 1 Tablet, Orally, Daily Mucinex DM 30 mg-600 mg oral tablet, extended release 1 Tablet, Orally, Q12H Myrbetriq 50 mg oral tablet, extended release 50 mg = 1 Tablet, Orally, Daily omeprazole 40 mg oral delayed release capsule 40 mg = 1 Capsule, Orally, Daily sertraline 100 mg oral tablet 150 mg = 1.5 Tablet, Orally, Daily solifenacin 5 mg oral tablet 5 mg = 1 Tablet, Orally, Daily Spiriva Respimat 1.25 mCg/inh inhalation aerosol 2.5 mCg = 2 Puff, Inhalation, Daily theophylline 400 mg/24 hours oral tablet, extended release 400 mg = 1 Tablet, Orally, BID torsemide 20 mg oral tablet 20 mg = 1 Tablet, Orally, Unscheduled, as needed for shortness of breath zafirlukast 10 mg oral tablet 10 mg = 1 Tablet, Orally, BID Zofran 4 mg oral tablet 4 mg = 1 Tablet, PRN, Orally, Q6H Active Scheduled Inpatient Medications albuterol-ipratropium (albuterol-ipratropium inh soln 2.5 mg-0.5 mg/3 mL), Inhalation SOLN, 3 mL, Neb Inhal, Q6H, Start: 12/15/22 19:00:00 cefePIME, Injection, 1 GM, IVPB, Q8H, Indication: Pneumonia - CAP (MRSA/PSA Risk Factors), Start: 12/15/22 20:00:00 heparin (heparin 5,000 units/0.5 mL injectable solution), Injection, 7,500 Units, Subcutaneous, Q8, Start: 12/15/22 22:00:00 Vancocin, Injection, 1.5 GM, IVPB, Q18H, Indication: Pneumonia - CAP (MRSA/PSA Risk Factors), Start: 12/15/22 21:00:00 Lactated Ringers 1,000 mL IV 125 mL/hr Sodium Chloride 0.9% 1,000 mL IV 100 mL/hr Sodium Chloride 0.9% 500 mL IV Other - See Comments One-Time Medications Given 12/14/22 00:00:00 TO 12/15/22 17:24:12 None Reported PRN Medications (0600 - 0559) from 12/14 - 12/15 acetaminophen, 650 mg, Orally, Q4H, 0 Dose(s) ondansetron, 4 mg, IV Push, Q6H, 0 Dose(s) polyethylene glycol 3350, 17 GM, Orally, Daily, 0 Dose(s) Allergies Plaquenil (Difficulty Breathing) sulfa drugs (Difficulty Breathing) Augmentin (Hives) Ceclor (Hives) codeine (Itching) Social History Alcohol Past, 1-2 times per month Electronic Cigarette/Vaping E-Cigarette Use Never. Employment/School Unemployed Home/Environment Lives with Spouse. Home equipment: CPAP/BiPAP. Other 2 children Substance Abuse Past, Marijuana Tobacco Tobacco Use: Former smoker, quit more than 30 days ago. Started age 13.0 Years. Stopped age 20 Years. Family History COPD - Chronic obstructive pulmonary disease: Mother, Father, Sister, Brother and Brother. Diabetes mellitus: Mother, Father, Brother and Grandmother (M). Diabetes mellitus type 1: Brother. Diabetes mellitus type 2: Sister and Child. ESRD - End stage renal disease: Brother. Heart attack: Father. Heart disease: Mother. Hypertension: Father. Kidney disease: Father. Kidney stone: Mother. Rheumatoid arthritis: Sister and Brother. Stroke: Father. Transplant of kidney: Brother. Lab Results All Labs Last 24 hours (No Micro or Pathology) Hematology: WBC: 19.1 k/cumm High (12/15/22 05:27:00) RBC: 3.3 million/cumm Low (12/15/22 05:27:00) Hgb: 9.5 GM/dL Low (12/15/22 05:27:00) Hct: 29.3 % Low (12/15/22 05:27:00) MCV: 89 fL (12/15/22 05:27:00) MCH: 28.9 pg (12/15/22 05:27:00) MCHC: 32.6 GM/dL (12/15/22 05:27:00) RDW: 15.6 % High (12/15/22 05:27:00) Platelet: 150 k/cumm (12/15/22 05:27:00) MPV: 9.9 fL (12/15/22 05:27:00) Chemistry: Sodium SerPl QN: 136 mmol/L (12/15/22 05:27:00) Potassium SerPl QN: 4.1 mmol/L (12/15/22 05:27:00) Chloride SerPl QN: 102 mmol/L (12/15/22 05:27:00) Carbon Dioxide SerPl QN: 23 mmol/L (12/15/22 05:27:00) Anion Gap: 11 mmol/L (12/15/22 05:27:00) BUN SerPl QN: 34 mg/dL High (12/15/22 05:27:00) Creatinine SerPl QN: 1.71 mg/dL High (12/15/22 05:27:00) Estimated GFR (CKD-EPI, no race): 35 mL/min/1.73m2 Low (12/15/22 05:27:00) Estimated CRCL (CG): 55 mL/min Low (12/15/22 05:27:00) Glucose SerPl QN: 126 mg/dL High (12/15/22 05:27:00) Calcium Total SerPl QN: 9.2 mg/dL (12/15/22 05:27:00) Troponin-I High Sensitivity: 4 ng/L (12/15/22 05:27:00) Lactate Venous Pl QN: 0.7 mmol/L (12/15/22 05:27:00) pH Bld Venous QN: 7.36 (12/15/22 09:28:00) PCO2 Bld Venous QN: 44 mmHg (12/15/22 09:28:00) PO2 Bld Venous QN: 58 mmHg High (12/15/22 09:28:00) Base Excess Bld Venous: -1 mmol/L (12/15/22 09:28:00) Bicarb Bld Venous Calc: 25 mmol/L (12/15/22 09:28:00) O2 Sat Bld Venous Calc: 88 % (12/15/22 09:28:00) FIO2: Venous (12/15/22 09:28:00) Patient Temperature: 37 DegC (12/15/22 09:28:00) Micro - Last 7 days Rapid Influenza Method: PCR - Liat (12/14/22 09:08:00) Rapid Influenza A PCR: Not Detected (12/14/22 09:08:00) Rapid Influenza B PCR: Not Detected (12/14/22 09:08:00) Diagnostics Radiology Results - Last 24 hours Across Visits 12/15/2022 08:20 - CT Chest W/O IV Contrast IMPRESSION: Limited exam in the absence of intravenous contrast.Multifocal airspace disease involving all lobes, including regions offrank consolidation involving both lower lobes, the lateral segmentof the right middle lobe, and posterior left upper lobe as describedabove. Numerous smaller patchy foci of airspace disease as well. Theappearance is nonspecific, with differential diagnosis includingatypical infection and multifocal inflammatory lung disease.Borderline/mild mediastinal and supra clavicular adenopathy.No overt malignant findings.Thank you for consulting with Radiology. Healthcare providerswishing to discuss this case further can contact. Signature Line Electronically Signed on 12/15/22 17:24 ________________________________________________________
Weitere VAERSDATA-Felder
- Praegender Schweregrund
- Acute respiratory failure
- Hospital-Tage
- -
- Labordaten
- COVID 19 Specimen Source Nasopharyngeal Coronavirus SARS-CoV2 Rapid * Not Detected Microbiology Studies - Bacterial Blood CX (+) POS In Progress NEG In Progress Resp CX + Stn NEG Bacterial L pneumo Urine Ag QL Not Detected L pneumo Urine Ag QL Interp L pneumo Urine Ag QL Interp Strep pneumo Ag Ur Not Detected Strep pneumo Ag Ur Interp Negative Staphylococcus spp Not Detected Staphylococcus aureus Not Detected Staphylococcus epidermidis Not Detected Staphylococcus lugdunensis Not Detected Streptococcus spp Not Detected Streptococcus agalactiae (Group B) Not Detected Streptococcus pneumoniae Not Detected Streptococcus pyogenes (Group A) Not Detected Enterococcus faecalis Not Detected Enterococcus faecium Not Detected Listeria monocytogenes Not Detected Enteric gram-negative bacilli Not Detected Enterobacter cloacae complex Not Detected Escherichia coli Not Detected Klebsiella aerogenes Not Detected Klebsiella oxytoca Not Detected Klebsiella pneumoniae group Not Detected Proteus spp Not Detected Salmonella spp Not Detected Serratia marcescens Not Detected Haemophilus influenzae (A) Detected Neisseria meningitidis Not Detected Pseudomonas aeruginosa Not Detected Stenotrophomonas maltophilia Not Detected Acinetobacter baumannii cmplx Not Detected Bacteroides fragilis Not Detected CTX-M Test Not Performed IMP Test Not Performed KPC Test Not Performed mcr-1 Test Not Performed mecA/C Test Not Performed mecA/C and MREJ (MRSA) Test Not Performed NDM Test Not Performed OXA-48-like Test Not Performed vanA/B Test Not Performed VIM Test Not Performed Candida albicans Not Detected Candida auris Not Detected Candida glabrata Not Detected Candida krusei Not Detected Candida parapsilosis Not Detected Candida tropicalis Not Detected Cryptococcus neoformans/gattii Not Detected Blood Pathogen Interp * Blood Pathogen Interp Viral FS Rapid Influenza Method PCR - Rapid Influenza A PCR * Not Detected Rapid Influenza B PCR * Not Detected
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