Reporte zur Charge 029H21B

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Patient is a 50 y.o. male patient of Physician with history of DM2, Hyperlipidemia, Hypertension, Hypothyroidism and Schizoaffective disorder presented to Emergency Department with cough, congestion and generalized flu like symptoms. Patient transferred to hospital due to hypoxia and lactic acidosis. Sepsis due to Covid-19 Virus Infection Met sepsis criteria with T 101.1, HR 128, lactate 3.3 Date of onset of symptoms: 8/5/23 Symptoms present on admission: tachycardia, fevers, congestion, cough, shortness of breath, myalgias Date of covid positive test: 08/07/23 Vaccination status: vaccinated Imaging: CXR- low lung volumes with pulmonary vascular congestion and bibasilar atel Patient is a 50 y.o. male patient of Physician with history of DM2, Hyperlipidemia, Hypertension, Hypothyroidism and Schizoaffective disorder presented to Emergency Department with cough, congestion and generalized flu like symptoms. Patient transferred to hospital due to hypoxia and lactic acidosis. Sepsis due to Covid-19 Virus Infection Met sepsis criteria with T 101.1, HR 128, lactate 3.3 Date of onset of symptoms: 8/5/23 Symptoms present on admission: tachycardia, fevers, congestion, cough, shortness of breath, myalgias Date of covid positive test: 08/07/23 Vaccination status: vaccinated Imaging: CXR- low lung volumes with pulmonary vascular congestion and bibasilar atelectasis Oxygen requirements on admission: 2L Current oxygen requirements: RA Medical therapy: dexamethasone from 8/7, remdesivir from 8/8. Stopped after 8/9 due to resolved O2 requirement Consultants following: None Anticipated special isolation end date: 8/16 based on symptoms Acute metabolic encephalopathy, improved According to patients caregiver, patient is verbal and active at baseline Only responsive to sternal rub on arrival Vitals were stable with unremarkable ABG TSH WNL, ammonia WNL CTH unremarkable Awake alert and interactive 8/8; resumed haldol at reduced dose 8/8 and full dose 8/9; transient sedation after full dose haldol, adjusted per below Acute respiratory failure with hypoxia, resolved Due to COVID Not on oxygen at home but requiring 2L NC on admission CXR as above Flu and rapid strep screens negative BNP 294, no sign of peripheral volume overload COVID per above Weaned to RA 8/9, then needed 1L again after sedation with home haldol, back to RA since Lactic acidosis Lactate 3.3 down to 2.0 after 2.6L bolus in total DM2, non insulin dependent Blood glucose 169 on labs in the ER A1c was 4.3 10/2022, repeat pending Holding home Metformin Glucose rising with steroid use and resuming diet Monitor accu checks and start SSI Lantus QAM while on steroid Resume home regimen on discharge Hypothyroidism Continue home Synthroid Schizoaffective personality disorder MRDD Patient has 24 hour supervision with home health aids Unsure of legal guardianship Held home Thorazine and Haldol due to lethargy VPA level 65 Resumed haldol at 5mg BID 8/8, increased back to home dose of 20mg BID 8/9 as he was becoming more agitated. Quite lethargic after first dose of 20mg; decreased to 10mg BID to resume 8/10 and continue at that dose on discharge Advised to resume thorazine in one week Further per the discretion of his outpatient psychiatrist, follows up once monthly

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PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE ACUTE NON ST ELEVATION MI

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The patient is a 77 y.o. female patient of a MD with history of chronic back pain, GERD, HLD, paroxysmal afib on coumadin, HTN, and peripheral neuropathy presented to the Hospital with cough and weakness. Acute hypoxic respiratory failure d/t COVID-19 pneumonia P/w 1 week history of headache, dry cough, and weakness. Pt reporting diarrhea x 2 days, now resolved (took imodium at home). Mild wheezing on exam, improved Pt fully vaccinated plus one booster Afebrile. Pt initially hypoxic at 87%, now satting >94% on room air ambulating CRP nl CXR: Perihilar coarsened interstitial markings and bronchial wall thickening Decadron 6mg daily for 10 days Encourage IS use PT/OT/SW Acute kidney injury vs CKD Initial Cr 1.1 remain at same level x 3, probably pt's baseline. GFR 50. Likely prerenal given poor PO intake secondary to diarrhea and COVID UA and urine culture ordered P Atrial fibrillation HTN/ HLD HDS on admission, slightly bradycardic ~ 59 Continue coumadin, flecainide, and diltiazem Pharmacy consulted for warfarin dosing, therapeutic now 3.5 Pre- DM Hba1c 5.9 BS elevated in context of steroids therapy. Diet education before discharge Chronic back pain PRN tylenol

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Patient is a 80 y.o. male patient of MD with history of CHF, CKD, Depression, DM Type 2, CAD, Hypertension, Peripheral Neuropathy, nephrolithiasis, TIA, Chronic diarrhea, Hyperlipidemia presented to Hospital with shortness of breath weakness, Fever and Cough . Pt medically ready for discharge, but lives alone with wife who is also admitted. Possible discharge of both on 3/5 Acute hypoxic respiratory failure due to Sepsis due to COVID-19 Infection hypoglycemia, tachypnea, fever up to 102.7 on adm. Now resolved Symptoms since 2/27, weakness, Fever and Cough. Tested positive 3/1/2023. Vaccinated x 2 plus 1 booster. Chest x-ray prominence of the bronchovascular markings Lactic acid unremarkable, CRP; 48.6. Procal nl Initially required 4 L of supplemental oxygen, now weaned to baseline room air. Started on dexamethasone, changed to Prednisone due ot adrenal insufficiency Received a Rocephin azithromycin, no clear signs of bacterial infection and procal nl so discontinued Cont IS/PEP Dizziness Intermittent for weeks now improved Orthostatic VS normal Meclizine ordered. PT/ OT consulted. Ambulating with walker AKI On CKD Stage 3 Hypokalemia Admission CR 2.58, baseline 1.7-2.1. Cr 1.9 at discharge On Lasix, dose recently decreased by Nephrologist as outpt. Avoid Nephrotoxic agent Nephrology consulted, Lasix ordered IV x 2. Will cont PO lasix 40 mg daily and resume BID at discharge PO potasium Adrenal insufficiency In context of acute infection. Hypoglycemia and hypotension on adm. Cortisol 3.8 random Pt with hx of DM, hypoglycemic on adm, has remained off medication and with BS <180 despite steroids treatment. Started on prednisone 40 mg, will wean to 20 mg at discharge x 7 days, then 10 x 7 days then cont 5 mg until seen by PCP Thrombocytopenia Platelets 138k, probably due ot COVID and sepsis. No signs of bleeding Monitor. DM with neuropathy Pt presented with hypoglycemia, required multiple doses of dextro, will stop MIVF w/ D5 now. Etiology multifactorial, poor PO intake and noted adrenal insufficiency Hba1c 6 Pt with hx of DM, hypoglycemic on adm, has remained off medication and with BS <180 despite steroids treatment. On Amaryl and Tresiba at baseline, will hold at this time, will not cont at discharge as pt controlled on steroids. Cont SSI Acute metabolic encephalopathy- resolved History of TIAs, cerebral infarcts stroke Does have occasional intermittent baseline confusion. Now complicated by hypoxemia COVID, acute on chronic renal failure and hypoglycemia CT head without contrast mild chronic small vessel white matter changes. Remote bilateral basal ganglia lacunar infarcts. Remote right thalamic lacunar infarct. Ammonium nl. B12/ folic elevated Chronic HFpEF Hx of PAF on coumadin Bradycardia, sinus Shortness of breath cough likely triggered by COVID infection. No other signs of volume overload. Does not have acute exacerbation Echocardiogram 2/8/2023 with EF 65.0 %. ProBNP 4656. Cont coumadin, pharmacy to dose, INR therapeutic. Strict input and outputs, daily weights Fluid restriction. Contaminated Blood culture BC 1/2 + Coag neg Staph. Monitor

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Patient is a 72 y.o. male of MD with history of rheumatoid arthritis, mitral valve regurgitation, hypertension, hyperlipidemia, CAD s/p CABG, atrial fibrillation, HFrEF with improved EF and recent COVID infection presented to the hospital with altered mental status and shortness of breath. He developed increasing oxygen requirements requiring high flow nasal cannula and eventually intubation on 2/1. Respiratory failure due to multifocal pneumonia, possible volume overload on background of lung disease from recent COVID infection. Completed 7-day course of Zosyn on 2/4. Briefly extubated on 2/5 however required reintubation. On 2/11 developed worsening hypotension, tachycardia and increase in inflammatory markers being started on broad-spectrum antibiotic for likely HAP. S/p trach/PEG 2/13. Acute respiratory failure with hypoxia Found to be hypoxic requiring 2 L nasal cannula at outside ED Thought multifactorial to a combination of edema, pneumonitis and recent COVID infection Increased oxygen requirements after admission requiring HHF and subsequently intubated on 2/1/23 Extubated and reintubated on 2/5 after developing increased work of breathing CT chest abdomen pelvis with contrast 2/11: Moderate marked bilateral pulmonary infiltrates Completed course of decadron Failed vent weaning due to mental status S/p Trach/PEG 2/13 Vent needs improving, tolerating PSV trials well, anticipate that he can be liberated from the vent over the next 1-2 weeks while at Select Toxic Metabolic Encephalopathy Reportedly had some AMS prior to presentation, but A&Ox 3 on presentation Course complicated by respiratory failure requiring intubation/sedation Has had agitation with sedation wean while intubated Now off of sedation, he is alert, trying to communicate via writing messages but nonsensical, suspect he has ongoing delirium Continue scheduled seroquel and oxycodone Sepsis Hypotension HAP BP as low as 81/56 at outlying ED, lactic acid 4.1 Hypotension thought secondary to sepsis although possibly due to medication Chest x-ray: Diffuse bilateral lung infiltrates, stable when compared to recent on 1/3/2023 Echo 11/2022: EF 58%, mild LVH, improved LV function when compared to prior Repeat Echo with EF 35%, severely enlarged LA in the setting of afib with RVR Completed 7d course of zosyn on 2/4 Hypotension and rising WBCs on 2/11; CT chest with persistent bilateral pulm infiltrates Blood cx from 2/11 with NGTD Sputum cx with growth of Serratia marcescens; pansensitive MRSA probe neg, stop Vanc Cefepime narrowed to ceftriaxone, continue through 2/18 Urinary Retention Failed TOV on 2/13 Attempted straight caths but had difficulty with some bleeding Foley replaced 2/14 Will need to re-attempt once able to mobilize Acute on Chronic HFpEF Echo 11/2022: EF 58%, mild LVH, improved LV function when compared to prior BNP 8860, increased from 2752 two weeks prior Chest x-ray: Diffuse bilateral lung infiltrates, stable when compared to recent on 1/3/2023 Repeat Echo with EF 35% in the setting of afib with RVR Cardio consulted, discussed adding beta-blocker if pressure tolerates Good response to lasix over 3L out 2/2 - 2/3 No need for further diuresis at this time Recent COVID infection Symptom onset 1/7/2023, tested positive on 1/12/2023 Vaccination status: Vaccinated Was outside of window for Paxlovid but treated briefly with Decadron Completed 20d isolation on 2/1 Completed a long course of IV decadron AKI Serum creatinine 1.42 on admission Baseline appears to be 0.7?0.9 Cr stable at baseline Transaminitis AST 156, ALT 163 on admission, Transaminases elevated in the setting of hypotension and shock liver LFTs now trending down, nearly normalized CAD Atrial fibrillation Hypertension s/p CABG S/p cardioversion in 6/2022 Was on amiodarone and carvedilol as an outpatient; amio stopped due to elevated LFTs, was not effective at rhythm control previously Transition off heparin gtt to eliquis HR intermittently elevated Increase metoprolol to 50mg BID (on coreg at home but due to soft Bps doubt he will tolerate) Holding home lisinopril and lasix due to low normal BPs Rheumatoid arthritis Home plaquenil and methotrexate held on admission Resumed home prednisone 10mg BID and plaquenil Continue hold methotrexate

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"Patient with history of COVID vaccines who admitted to hospital with COVID detected PCR. Provider d/c note: ""86 yo female, with PMH significant for OSA on CPAP, asthma, bipolar depression, HTN, who presented from nursing home to the ED today due to decreased responsiveness and fevers Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) treated in intensive care unit setting initially for urosepsis, E coli bacteremia, NSTEMI 1/7 Transferred to general floor 1/8 Underwent nuclear cardiac stress tests-ischemia of the lateral wall, mild 1/ 10 Seen by Cardiology, started on beta-blocker 1/11 Planned discharge to SNF on hold due to rising leukocytosis, leukocytosis improved down to 14 K the time of discharge Altered mental status, Improving gradually, most likely due to urosepsis Has significantly improved History of bipolar depression Continue with Tegretol and Cymbalta History of asthma Oxygen p.r.n., albuterol inhalers History of OSA On CPAP NSTEMI Appreciate cardiology consultation, echo showed normal LVEF of 55-60%, mild AS Giving IV heparin for 48 hours On aspirin, beta-blocker nuclear stress test,1/ 9 , as Cardiology, mild reversible defect, in the lateral wall consistent with mild ischemia, Cardiology recommended to treated medically , with beta-blocker, patient already on aspirin Urosepsis with E coli bacteremia Was on Levophed in intensive care unit setting Weaned of Levophed On ceftriaxone from 01/05, anticipate total course of antibiotic of 10 days at least Leukocytosis improving, has normalized 1/11 significant rise in leukocytosis to 19 K, planned discharge to SNF on hold No fever, patient does not look toxic, currently on IV Rocephin Has anion gap acidosis with bicarb of 15, check lactic acid, do sepsis workup, including blood culture History of hypertension PTA antihypertensives on hold Acute kidney injury, solitary right kidney, status post left nephrectomy Due to urosepsis, improving renal function Possible cognition impairment, move Moca scoring by speech, checked vitamin B12. Normal Condition at the time of discharge- Vss Constitutional: No distress, elderly, 2 liters/minute HENT: Normocephalic, Atraumatic, Pupils Reactive, Normal oropharynx, Nose normal. Cardiovascular: Normal heart rate, Normal rhythm, No murmurs, No rubs, No gallops. Respiratory: Normal breath sounds, No respiratory distress, No wheezing, No chest tenderness. GI: Bowel sounds normal, Soft, No tenderness, No masses, No pulsatile masses. Extremities: Intact distal pulses, No edema, No tenderness, No cyanosis, No clubbing. Neurologic: Alert & oriented x 2 , confused at times, No focal deficits noted. Skin: Warm and dry Issues Requiring Follow Up: (Who, what, when, and how communicated?) Losartan & Aldactone are on hold till f/u BMP & CBC , renal function improvement To follow-up on tolerance and efficacy of Augmentin"""

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shortness of breath called 911 around noon admitted to ER around 1pm tests in ER determined Bilateral Pulmonary Embolism Pushed meds to help dissolve clots Intubated to help breath as meds were pushed Passed away before being transferred from ER to ICU around 11:30pm same day

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Minor stroke. Drooping face, slurred speech. Symptoms subsided after 5 minutes.

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A 58 y.o. female patient of CNP with history of HTN, HLD, COPD, chronic hypoxemic respiratory failure, chronic HFPEF who presented with respiratory distress. Symptoms worsened overnight with altered mental status, required intubation. Shock. Cardiogenic vs Septic; Aspiration Pneumonia; Pneumonia due to COVID-19; CT pulmonary arteries on 8/8/2022: cardiomegaly with sm-mod pericardial effusion; left lower lobe multi segmental mucoid; impaction; negative for PE; Status post intubation on 8/9; No longer requiring pressors; ID following; Repeat echo pending; Critical care signed off; Discontinue cefepime; Finished dexamethasone and remdesivir; Covid-19 Virus Infection; Date of onset of symptoms: 8/8/2022; Symptoms present on admission: shortness of breath, altered mental status, fever; Date of covid positive test: 8/8/2022; Vaccination status: vaccinated; Imaging: CTA pulmonary arteries; Oxygen requirements on admission: 8L; Current oxygen requirements: BiPAP; Medical therapy: steroids; pending hepatic panel - Remdesivir; Consultants following: Pulm CC, ID; Anticipated special isolation end; date: 8/17/2022; Completed treatment; Acute on chronic hypoxemic respiratory failure; COPD; Wears 3.5 liters chronically; AVAPs; Intubated initially; Currently on NC; Continue with nebs, antibiotics; extubated on 8/10; Critical care signed off; Acute Kidney Injury on CKD stage III, with ATN; CKD stage III with baseline creatinine 0.79-1. Likely due to shock; Creatinine peaked at 1.96; Renal neg for stones or hydronephrosis, 5.7 cm adrenal gland mass noted; Continue close monitoring, monitor urine output; Resolved; Acute metabolic encephalopathy -resolved; DM Type II; HgA1c on 6/11/2022: 5.9; Accucheck every 4 hours with ISS coverage; HFpEF; Pericardial Effusion TTE on 7/12/2022: LVEF 66%, grade II diastolic dysfunction, large pericardial effusion; echo densities attached to visceral pericardium. Repeat TTE. Hold diuretics, diurese as BP allows. Paroxysmal Atrial Fibrillation; Eliquis discontinued in mid July due to pericardial effusion; Hold Metoprolol while hypotensive.; Currently rate controlled. Maintain K>4, Mag >2. Adrenal gland mass; On right per renal ultrasound; Also noted on CT pulmonary angiogram, 5.7 cm; Will handle acute issues at this time and Patient follow-up as outpatient; HTN; Hold antihypertensive medications while on vasoactive medications. Restarted metoprolol. Consider adding lisinopril/hydrochlorothiazide and amlodipine as able. Dyslipidemia. Continue Atorvastatin, Chronic Anemia. Baseline hemoglobin 8-9. Currently 10.8. Continue Ferrous sulfate, Coronary Artery Disease; Continue aspirin, statin; Hold anti hypertensive medications. Severe malnutrition, POA; Consult dietitian; Constipation; Chronic history; Reports no BM since admission; On colace and miralax; Anxiety; Tremors; Patient is on Xanax and paroxetine at home as well as trazodone; Trazodone restarted on 8/13; Per patient request, will restart Xanax on 8/14; Continue paroxetine Patient stable for discharge today home with home health. However patient's home getting treatment for bugs, therefore discussed with social work case management and patient will be remaining in the hospital until this is completed.

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Admission Date: 7/15/2022 PRESENTING PROBLEM: Subarachnoid hemorrhage Intracranial hemorrhage HOSPITAL COURSE: Patient is a 75 year old with a PMHx of ESRD on HD, Type 2 diabetes, CHF, HTN, HLD, GERD, SBO, diverticulitis, abdominal abscess s/p ex lap with colostomy and chronic pancreatitis that presented 7/15/2022 with an acute spontaneous subarachnoid hemorrhage. A head CT was completed that revealed a large left frontotemporal ICH, diffuse SAH, 8 mm MLS, and hydrocephalus. CTA head/neck demonstrated concern for Left MCA aneurysm. Patient was taken emergently to the OR for left MCA aneurysm clipping and left hemicraniectomy with ICH evacuation. Post operatively a DCA was completed that showed complete occlusion of left MCA aneurysm w/small neck remnant, head CT with stable postoperative findings, slight worsening of hydrocephalus, improvement in MLS to 6 mm. Patient also had an EVD placed for obstructive hydrocephalus. Patient was admitted to the Neuro ICH for subarachnoid hemorrhage management. She was started on CRRT given ESRD. Postoperatively, patient was weaned off sedation but remained a GCS <8. Right facial and upper extremity twitching was noted and EEG placed which demonstrated focal status epilepticus with left frontal origin. She was started on keppra and valproic acid with minimal improvement. Therefore, pt started on versed infusion. On 7/18, pt continued to be in focal status, therefore she was administered 4mg ativan, versed increased to 0.5mg/kg/hr and loaded with fosphenytoin with subsequent cardiac arrest. Resuscitation efforts attempted, family present at bedside and DPOA requested efforts cease. Please see critical event notes for further detail. Time of death 0928 on 7/19/2022.

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12/28/2021 to emergency room for nosebleeds, gum bleed, melena, GI bleed and fatigue. Severe thrombocytopenia and acute on chronic normocytic anemia. Required transfusion of blood and platelets. Treated for ITP. Stabilized and discharged on 01/04/2022. Multiple comorbid conditions. Failure to thrive. Patient died 01/14/2022.

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Collapsed and died.

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Presented to the hospital with right sided weakness and small L MCA stroke 3/3/22, which evolved to a large hemispheric left MCA stroke 3/8/22 with malignant cerebral edema requiring decompressive hemicraniectomy 3/9/22. Examination remained poor with essentially vegetative state. She underwent tracheostomy and PEG tube placement.

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Pfizer COVID Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/14/2021, 1/31/2021 and 12/27/2021. Presented to ED 2/4/2022 c/o generalized weakness, fatigue, and high output from his ostomy. Admitted for septic shock, acute cycstitis, Covid19 requiring O2. Course c/b AKI w/azotemia, hperkalemia, metabolic acidosis and acute metabolic encephalopathy delirium. Tx'd w/decadron and Tylenol. Transitioned to comfort care instituted and expired 2/17/22.

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Hospitalized (12.19.21 - 12.22.21); COVID-19 positive (12.10.21); Fully vaccinated PLUS Booster - moderna d/c summary: Discharge Summary MD (Physician) ? ? General Medicine Hospitalist D/C Summary BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 12/19/2021 Discharge Date: 12/22/2021 Active Hospital Problems Diagnosis Date Noted POA ? Acute hypoxemic respiratory failure due to COVID-19 12/19/2021 Yes ? CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min 12/19/2021 Yes ? CLL (chronic lymphocytic leukemia) 12/19/2021 Yes ? Pneumonia due to COVID-19 virus 12/19/2021 Yes ? Junctional bradycardia 12/19/2021 Yes Resolved Hospital Problems Diagnosis Date Noted Date Resolved POA ? Acute on chronic diastolic congestive heart failure 12/19/2021 12/22/2021 Yes Pre-Existing Active Problems Diagnosis Date Noted POA ? Anemia 11/18/2020 Unknown ? Complete heart block 02/01/2020 Unknown ? Microscopic colitis 03/03/2010 Unknown DISCHARGE DISPOSITION: The patient was discharged to SNF No future appointments. Appointments Needing to be Scheduled Contact information for follow-up DO Specialty: Family Medicine Relationship: PCP - General Next Steps: Follow up Instructions: Please call to schedule a post-hospitalization follow-up appointment with your Primary Care provider in 7-10 days. At your appointment, talk to your provider about how you are feeling since being in the hospital. Instructions for after discharge Adult Diet Complete by: As directed Daily Weights Complete by: As directed Early and Progressive Mobility Complete by: As directed Occupational Therapy Evaluate and Treat at Receiving Facility Complete by: As directed Physical Therapy Evaluate and Treat at Receiving Facility Complete by: As directed DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: The patient is a 94-year-old female with a history of CLL on venetoclax, CKD stage 4, chronic diastolic heart failure, stasis dermatitis of her lower extremities as well as junctional bradycardia, who presented with increasing shortness of breath, cough and hypoxia on 12/19. Patient is fully vaccinated with Moderna vaccination including recent booster. The patient had the onset COVID symptoms on 12/16 with a positive test on 12/19. Chest x-ray performed in the emergency department showed prominent interstitial opacities with a component of interstitial pulmonary edema. COVID testing was negative and the patient was admitted and started on dexamethasone and remdesivir. ProBNP was elevated on admission at 8461, and the patient received 1 dose of IV Lasix. Patient's creatinine subsequently increased to 1.81, and further doses of Lasix were held. Remdesivir was discontinued due to worsening renal function. With supportive care and further treatment with dexamethasone the patient had improvement in her respiratory status, appetite and oral intake. She was seen by PT/OT who recommended subacute rehab. As patient was clinically stable, with stable renal function, stable O2 saturations on 2 L/Min she was transition to oral dexamethasone and discharged to skilled nursing on 12/22/2021. CONSULTATIONS None INPATIENT PROCEDURES None PHYSICAL EXAM: BP 100/73 | Pulse (!) 41 | Temp 36.4 ?C (Axillary) | Resp 20 | Wt 66.7 kg | SpO2 97% | BMI 27.06 kg/m? Physical Exam Vitals and nursing note reviewed. Constitutional: General: She is not in acute distress. Appearance: Normal appearance. She is well-developed. HENT: Head: Normocephalic. Ears: Comments: Significant presbycusis present Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: No oropharyngeal exudate. Eyes: Conjunctiva/sclera: Conjunctivae normal. Cardiovascular: Rate and Rhythm: Regular rhythm. Bradycardia present. Heart sounds: No murmur heard. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: No wheezing. Comments: Diminished breath sound Abdominal: General: Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: General: Normal range of motion. Cervical back: Normal range of motion and neck supple. Right lower leg: No edema. Left lower leg: No edema. Skin: General: Skin is warm. Findings: No rash. Neurological: Mental Status: She is alert and oriented to person, place, and time. H&P: Attestation signed by MD at 12/20/2021 1:55 PM Patient did have some complaints of shortness of breath at the bedside and did have some mild coarse breath sounds heard bilaterally. Otherwise, patient overall seems to be doing fairly well. Agree with continued use of diuretics. Patient asymptomatic in regards to intermittent bradycardia. Will monitor clinically. Will need subacute rehab. Baseline renal function from early 2020 shows creatinine of approximately 1.6 - 1.7 on average. Expand All Collapse All Hide copied text Hover for details CHIEF COMPLAINT: Acute hypoxemic respiratory failure due to COVID-19 Assessment/Plan ASSESSMENT / PLAN: * Acute hypoxemic respiratory failure due to COVID-19 Assessment & Plan Likely multifactorial with COVID and CHF On 4L NC Continue lasix and dexamethasone Wean oxygen as tolerated Pneumonia due to COVID-19 virus Assessment & Plan Symptom onset: 12/16 Isolation: Severe Respiratory, if improved/afebrile antipyretics consider deescalation on 1/4 due to immune compromised status Vaccination Status: Vaccinated in Feb/March, has had booster although unsure of date Continue supplemental O2, Titrate/wean to maintain SpO2>92% Continue Dexamethasone 1/10 Continue Remdesivir 1/5, will have to continue to monitor renal function closely Encourage Self Prone, IS, deep breathing and ambulation as tolerated Symptomatic Treatment: Anti Tussives, Anti Emetics, Analgesics VTE PPx: Lovenox 40mg SQ q24 Daily CBC, CMP, CRP, D-Dimer Monitor I/O, daily weight, creatinine Maintain net neutral to negative fluid balance q24 Code Status: DNR Junctional bradycardia Assessment & Plan Seen by cardiology at Hospital last month, no intervention needed. Daughter states that they spoke with Dr. who said a pacemaker was not needed as her heart never stops and she does not have symptoms with her bradycardia EKG showing junctional rhythm with rate of 46 CLL (chronic lymphocytic leukemia) Assessment & Plan On venetoclax for CLL, hold with acute infection Follows with palliative care as an outpatient CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min Assessment & Plan Renal function appears better than baseline Continue to monitor with diuresis Acute on chronic diastolic congestive heart failure Assessment & Plan Patient had an echo in 11/2021 with EF 70% BNP elevated today 8461 CXR showing pulmonary edema vs infiltrates Given IV lasix 20 mg in ER, continue with BID IV lasix Monitor I/O, daily weights Subjective HISTORY OF PRESENT ILLNESS: Patient is a 94 y.o. female who presents today with shortness of breath, hypoxia and weakness. The patient has a complex medical history including CKD 4, CLL, bradycardia, CHF, previous DVT not on anticoagulation. She is very hard of hearing and so cannot provide a lot of history due to not understanding all of my questions. I did speak with her daughter on the phone to assist with the history. The patient was hospitalized at Hospital from 11/14-11/19 for a UTI, metabolic encephalopathy and CHF. She was discharged to rehab. Daughter reports that after 9 days she had improved and was told she did not need rehab but was unable to return home so went to another facility for respite. While there she has had increasing shortness of breath but her oxygen levels have been above 90 so she did not need oxygen. The facility reported that over the last 2-3 days she has had increasing weakness. Her daughter states she was there yesterday and she seemed to be at her baseline. Today the patient was found to be hypoxic and so EMS was called and she was brought to the ER for evaluation. The patient states that she occasionally has been having achy chest pain but does not have any today. She has some shortness of breath and an occasional cough. She states she has been tired and had some chills. In the ER the patient was found to be COVID positive. She had an elevated BNP at 8461. Her troponin was indeterminate with a delta of 3. She had no leukocytosis, a negative procal. Her EKG showed junctional rhythm with a rate of 46 and some ST and T wave abnormalities. She had a CXR showing prominent interstitial opacities bilaterally possible pulmonary fibrosis and or interstitial pulmonary edema and bibasilar atelectasis vs infiltrate. She was hypoxic requiring supplemental oxygen and was given lasix. The hospitalist team was contacted for admission and further management. Patient Active Problem List Diagnosis ? Microscopic colitis ? Complete heart block ? Anemia ? Acute hypoxemic respiratory failure due to COVID-19 ? Acute on chronic diastolic congestive heart failure ? CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min ? CLL (chronic lymphocytic leukemia) ? Pneumonia due to COVID-19 virus ? Junctional bradycardia Review of Systems Constitutional: Positive for activity change, chills and fatigue. Negative for fever. HENT: Negative for congestion and sore throat. Eyes: Negative for visual disturbance. Respiratory: Positive for shortness of breath. Negative for cough. Cardiovascular: Positive for chest pain (intermittent) and leg swelling. Gastrointestinal: Positive for abdominal pain. Negative for nausea, vomiting and diarrhea. Genitourinary: Negative for difficulty urinating and dysuria. Musculoskeletal: Negative for back pain and falls. Neurological: Positive for weakness. Negative for dizziness and light-headedness. Endo/Heme/Allergy: Positive for easy bleeding or bruising. Skin: Positive for wound. Negative for rash. Objective OBJECTIVE: BP 124/55 | Pulse (!) 47 | Temp 36.4 ?C (Axillary) | Resp 28 | Wt 66.7 kg | SpO2 99% | BMI 27.06 kg/m? Physical Exam Constitutional: General: She is not in acute distress. Appearance: Normal appearance. She is not diaphoretic. HENT: Head: Normocephalic and atraumatic. Ears: Comments: Very hard of hearing Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. Eyes: Extraocular Movements: Extraocular movements intact. Conjunctiva/sclera: Conjunctivae normal. Cardiovascular: Rate and Rhythm: Regular rhythm. Bradycardia present. Pulses: Normal pulses. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: No wheezing. Comments: Lung sounds diminished in bilateral bases, some scattered fine crackles bilaterally Abdominal: General: Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: Right lower leg: Edema present. Left lower leg: Edema present. Comments: LLE>RLE edema Skin: General: Skin is warm and dry. Comments: See photo below of wound on right shin Neurological: Mental Status: She is alert and oriented to person, place, and time. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal.

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ACUTE PERICARDITIS, UNSPECIFIED 7/16/2022 & 9/18/2022 -- RECURRENCE OF SAME SYMPTOMS

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Breakthrough infection with COVID19. I woke up on 5/11 with dry hacking cough. Later that day developed fever, headache, body aches. Was prescribed Paxlovid by PCP (via telehealth visit) and started taking it that afternoon. I had injured my back on 5/6 and was prescribed (via telehealth visit on 5/9) Methylprednisolone 4Mg Dose Pack , which I started taking that day. Per PCP instructions when receiving Paxlovid prescription I stopped taking the Methylpredisolone immediately, last does was 5/10 at bedtime (about 10 PM). COVID symptoms stayed for about 3 days. I did experience some "COVID rebound" symptoms 6-8 days after starting Paxlovid, primarily recurrence of cough - primarily in the morning, about 5-15 after getting out of bed, mildly productive, prompted by some fluid/mucus in lungs. Once lungs are clear minimal coughing during the day. This has been getting better but I am still experiencing this lingering morning cough.

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Patient is a 78 yo M with hx paroxysmal atrial fibrillation, dilated cardiomyopathy with systolic and diastolic CHF, arthrosclerotic heart disease, mixed hyperlipidemia, moderately differentiated invasive ductal carcinoma of the left breast in a male s/p bilateral mastectomy, history of alcoholism and peptic ulcer who presented with lethargy and seizure like activity. No reported focal neurological deficits. Patient did have some visual loss that was improving early in hospitalization. Patient found to have bilateral occipital lobe and right cerebellar stroke. Patient started on ASA, continued eliquis, lipitor. Patient with worsening lethargy and respiratory acidosis in PM on 2/6. Suspect multifactorial in setting of ativan from CIWA protocol, COPD. Patient intubated on 2/6 after patient did not improve with BiPAP. Patient started on steroids. Patient has been on precedex and fentanyl for sedation. After intubation patient was noted to have seizure like activity with vertical nystagmus and jerking of extremities. Patient loaded on keppra and started on 500 mg BID for maintenance. STAT EEG and did not show epileptic activity on 2/7 or 2/8 but patient having intermittent seizure like activity. Keppra increased to 1000 mg BID. Routine exam may have not captured event. We cannot do continuous EEG monitoring at or facility. No recurrent episodes since increasing keppra. Hospitalization also complicated by Afib w/ RVR. Tikosyn discontinued due to QTC prolongation and diltiazem gtt started 2/7. Pt transferred for higher level of care to hospital on 2/8.

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heart was fluttering/flutter was really bad; woke up at 3 AM and fainted; like a pressure/ felt like there was a lot of pressure in her chest/ She felt like someone had their knee right in the center of her chest, between her breasts; had severe chest pain; sweating; Inappropriate schedule of vaccine administered; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC FLUTTER (heart was fluttering/flutter was really bad) and SYNCOPE (woke up at 3 AM and fainted) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 029H21B) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Anaphylaxis, Hives and Hay fever. Previously administered products included for Product used for unknown indication: COVID-19 VACCINE NRVV AD26 (Time: 10:00 AM; Lot/Batch: 206A21A; Route and body site: Left arm) on 19-Jun-2021. Past adverse reactions to the above products included No adverse event with COVID-19 VACCINE NRVV AD26. Concurrent medical conditions included Fruit allergy (anaphylaxcic shock, swelling, difficulty breathing, hives) since 12-Apr-1998. On 03-Dec-2021 at 11:30 AM, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Dec-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered). On 04-Dec-2021, the patient experienced CHEST PAIN (had severe chest pain). 04-Dec-2021, the patient experienced HYPERHIDROSIS (sweating). On 04-Dec-2021 at 3:00 AM, the patient experienced CARDIAC FLUTTER (heart was fluttering/flutter was really bad) (seriousness criterion medically significant), SYNCOPE (woke up at 3 AM and fainted) (seriousness criterion medically significant) and CHEST DISCOMFORT (like a pressure/ felt like there was a lot of pressure in her chest/ She felt like someone had their knee right in the center of her chest, between her breasts). On 03-Dec-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered) had resolved. On 04-Jan-2022 at 1:00 PM, CARDIAC FLUTTER (heart was fluttering/flutter was really bad), SYNCOPE (woke up at 3 AM and fainted) and CHEST DISCOMFORT (like a pressure/ felt like there was a lot of pressure in her chest/ She felt like someone had their knee right in the center of her chest, between her breasts) had resolved. At the time of the report, CHEST PAIN (had severe chest pain) and HYPERHIDROSIS (sweating) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure measurement: 138/80 (High) 138/80. On an unknown date, Blood test: normal (normal) Normal. On an unknown date, Blood thyroid stimulating hormone: normal (normal) Normal. On an unknown date, Body temperature: 98 degrees f (normal) 98 degrees f. On an unknown date, Chest X-ray: normal (normal) Normal. On an unknown date, Electrocardiogram: normal (normal) Normal. On an unknown date, Full blood count: normal (normal) Normal. On an unknown date, Heart rate: abnormal (abnormal) heart is beating really hard/rapid heart beat and 76 (normal) 76. On an unknown date, Laboratory test: 19 (normal) 19 and normal (normal) Normal. On an unknown date, Metabolic function test: normal (normal) Normal. On an unknown date, Oxygen saturation: 97 % (normal) 97 %. On an unknown date, Troponin: normal (normal) Normal. Symptoms experienced by the patient reported as irregular heart rate/palpitations, heart rate greater than 100 beats per min, chest tightness, decreased level of consciousness, feeling hot. Event cause the patient to seek medical care. Patient was on emergency room/department from 18-Dec-2021 to 19-Dec-2021. No concomitant medication information was provided. No treatment medication was provided. Company Comment - This is a spontaneous case concerning a 61-year-old female patient with no relevant medical history provided, who experienced the serious and unexpected event of cardiac flutter and the expected event of syncope. On 03-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine). The events occurred 1 day after the second dose of mRNA-1273 vaccine, and had resolved on the same day. The rechallenge was unknown. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 04-Jan-2022: Follow-up information was received and had no new information. On 15-Jan-2022: Follow up received as medical history, lab data and event added.; Sender's Comments: This is a spontaneous case concerning a 61-year-old female patient with no relevant medical history provided, who experienced the serious and unexpected event of cardiac flutter and the expected event of syncope. On 03-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine). The events occurred 1 day after the second dose of mRNA-1273 vaccine, and had resolved on the same day. The rechallenge was unknown. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.

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heart was fluttering/flutter was really bad; woke up at 3 AM and fainted; had severe chest pain; like a pressure/ felt like there was a lot of pressure in her chest/ She felt like someone had their knee right in the center of her chest, between her breasts; Inappropriate schedule of vaccine administered; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC FLUTTER (heart was fluttering/flutter was really bad) and SYNCOPE (woke up at 3 AM and fainted) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 029H21B) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Previously administered products included for Product used for unknown indication: COVID-19 VACCINE NRVV AD26. Past adverse reactions to the above products included No adverse event with COVID-19 VACCINE NRVV AD26. On 03-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Dec-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered). On 04-Dec-2021, the patient experienced CARDIAC FLUTTER (heart was fluttering/flutter was really bad) (seriousness criterion medically significant), SYNCOPE (woke up at 3 AM and fainted) (seriousness criterion medically significant), CHEST PAIN (had severe chest pain) and CHEST DISCOMFORT (like a pressure/ felt like there was a lot of pressure in her chest/ She felt like someone had their knee right in the center of her chest, between her breasts). On 03-Dec-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered) had resolved. In December 2021, CHEST DISCOMFORT (like a pressure/ felt like there was a lot of pressure in her chest/ She felt like someone had their knee right in the center of her chest, between her breasts) had resolved. At the time of the report, CARDIAC FLUTTER (heart was fluttering/flutter was really bad) had not resolved and SYNCOPE (woke up at 3 AM and fainted) and CHEST PAIN (had severe chest pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood test: normal (normal) Normal. On an unknown date, Blood thyroid stimulating hormone: normal (normal) Normal. On an unknown date, Chest X-ray: normal (normal) Normal. On an unknown date, Electrocardiogram: normal (normal) Normal. On an unknown date, Full blood count: normal (normal) Normal. On an unknown date, Heart rate: abnormal (abnormal) heart is beating really hard. On an unknown date, Laboratory test: normal (normal) Normal. On an unknown date, Metabolic function test: normal (normal) Normal. On an unknown date, Troponin: normal (normal) Normal. No concomitant medication information was provided. No treatment medication was provided. Company comment:This is a spontaneous case concerning a 61-year-old female patient with no relevant medical history provided, who experienced the serious and unexpected event of Cardiac flutter with the non-serious unexpected events of Inappropriate schedule of vaccine administered, Chest discomfort, and Chest pain. On 03-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine). The event of Inappropriate schedule of vaccine administered occurred on the same day, with all other events occurring on the following day. The rechallenge was unknown since there's no information about the first two doses. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report; Sender's Comments: This is a spontaneous case concerning a 61-year-old female patient with no relevant medical history provided, who experienced the serious and unexpected event of Cardiac flutter with the non-serious unexpected events of Inappropriate schedule of vaccine administered, Chest discomfort, and Chest pain.On 03-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine). The event of Inappropriate schedule of vaccine administered occurred on the same day, with all other events occurring on the following day. The rechallenge was unknown since there's no information about the first two doses. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report

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Patient states he began to experience chills, syncope, and fever reaching 102.8 at around 7pm on 12/23, and had to go to the ED on 12/24 where he had to remain overnight and was treated with IV fluids and acetaminophen. He was told his syncope was unrelated to the vaccine, and is not certain if he received any other medications.

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Hives all over body. Anaphylaxis and taken to a local Hospital Emergency Room in December 24th 2021. Taken to an urgent care on December 17th 2021 to seek allergy testing.

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Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient passed out and came to quickly. Monitored him for about an hour.

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Site: Pain at Injection Site-Mild, Systemic: Fainting/Syncope-Mild, Additional Details: Patient fainted after receiving the vaccine. Ambulance arrived to take patient to the nearby hospital. Patient recovered alert and oriented x 3. BP 107/88; HR 86; Oxygen 97%; RR 18. Patient declined ER visit via ambulance. Stayed outside the clinic for 15 minutes and went shopping inside.

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Systemic: Fainting / Unresponsive-Severe, Additional Details: Pregnant (newly pregnant) patient fainted upon vaccination. She stated she has a history of fainting with injections from when she was younger, but did not inform the immunizer since it had not happened in a long time. She fainted and pharmacist and pharmacy intern lowered to safety, she was responsive within about 20 to 30 seconds. Made patient wait about 30 minutes before having family member drive her home, and informed her she should let her OB know this happened.

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Systemic: Patient fainted while she was seated waiting for 15 minutes-Mild.

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Systemic: Fainting / Unresponsive-Mild, Additional Details: pt fell and hit his head, paramedicas came and found him to be responsive and let him go after 20 minutes of observation. Seemed to be focused afterward, could stand without any problems

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Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium

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Systemic: Fainting / Unresponsive-Mild

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Pregnancy through IVF due date 8/12/21 Approximately an hour after receiving the vaccine, I started having severe vaginal bleeding (more than 1 pad per hour) with large blood clots consistent with a miscarriage. The heavy bleeding lasted for approximately 5 hours and then lightened to a medium period rate, by the next morning it was just spotting and as of today (12/13) I am still experiencing some spotting. An ultrasound and HCG test showed that there is still one healthy embryo. A second ultrasound will be taken on 12/15 to confirm. It is uncertain if there had original been multiples or what caused the bleeding. A tissue sample was not taken.

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Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Hypotension-Severe, Systemic: Weakness-Medium, Additional Details: Fainted shortly after receiving Moderna booster. First 2 doses had been Pfizer. Patient reported almost fainting after Pfizer but not until after event. Hit forehead on hard floor, had a small cut, will probably bruise. Severe sweating. EMTs performed heart monitoring and decided to admit to hospital. Heart rate was measured as low as 38 BPM

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Systemic: Dizziness / Lightheadness-Medium, Systemic: patient fainted-Medium, Additional Details: patient passed out about 20 seconds after recieving vaccine she regained conciousness after about 5-10 seconds she stuck around the pharmacy for 30 minutes instead of the 15 minutes and she was given water and snacks incase low blood sugar was also part of the issue. Patient seemed okay when she left.

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Systemic: Fainting / Unresponsive-Severe, Additional Details: THE PATIENT DESCRIBED FEELING LIGHTHEADED AFTER HIS VACCINATION. HE BECAME ALMOST UNRESPONSIVE WHILE SITTING IN THE VACCINE ADMINISTRATION AREA WHEREBY I WENT TO GET a staff member FOR ASSISTANCE. WE WERE ABLE TO GET THE PATIENT INTO A SUPINE POSITION AND staff member MEASURED HIS BLOOD PRESSURE, WHICH WAS APPROXIMATELY 70/50. Staff member WAS UNABLE TO GET A O2 READING ON THE PULSOXIMETER AT WHICH POINT WE CALLED 911. THE PATIENT LEFT ON HIS OWN AFTER EVALUATION BY THE EMTS.

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Patient with history of COVID vaccines who admitted to hospital with COVID detected PCR. Provider d/c note: "Patient, 62 yo non-verbal female with history of CVA, dysphagia, aphasia, hemiparesis, PEG tube, schizophrenia and diabetes who presented to the ER from her residential facility for concern of emesis and hypoxemia. She was found to be COVID+ with bilateral aspiration pneumonia. On initial presentation she was found to be septic with hypotension, tachycardia, leukocytosis and elevated lactic acid. She was initially requiring oxygen and decadron for hypoxemia however was able to wean off of the oxygen with good saturation on room air. Initially started on zosyn for aspiration pneumonia and was able to be transitioned to Augmentin for a 5 day course. She was able to resume tube feeds, tolerated well and oxygenation remained good and she was discharged back to her residential facility with continue supportive care for COVID and augmentin for aspiration pneumonia."

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Reason for Admission: dyspnea 2/2 COVID vs. Bacterial pneumonia Brief Summary of Hospital Stay: patient is a 66 YO male with h/o lung transplant for IPF, MDS, CKD IV, HTN, hypothyroidism, OSA, CHF presenting for evaluation of subjective dyspnea without the need of oxygen. Found to be COVID positive and pancytopenic. He is following with facility and Dr. Per facility transplant specialist ok to be treated here and may be transferred there any time the need would arise or if he would worsen. Got one unite of irradiated PRBCs, was treated with Remdesivir (discussed with Dr. - transplant specialist, that in spite of his CKD stage IV ok to give; 3 days per protocol if not needing oxygen, if needing oxygen, then total of 5 days, completed 5 days prior to discharge), Rocephin and doxycycline - as discussed with facility specialist; Still the patient continued to decline clinically and started requiring oxygen. Chest x-ray showed likely increased infiltrates vs atelectasis. Regimen was switched to Doxy, vanc and zosyn and decadron added. ABG showed mild respirator alkalosis. Changes were made in discussion with Dr. On day 3, due to worsening clinical status decision was made to transfer to transplant service and he was gracefully accepted there. A bed was available the same night, however patient decided to wait until the morning due to being extremely tired, however the bed was not available in the morning any more. On day 5 a bed became available again and patient was discharged. D-dimer elevated on arrival, but about his baseline and improved on day 3, troponins elevated but downtrending during the stay. Kidney function stable. Due to worsening thrombocytopenia and anemia he received irradiated platelet and PRBC transfusions prior to discharge in discussion with hem/onc on call Dr.

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I95.9 HYPOTENSION 2/25/2022 HYPOTENSION I95.9 HYPOTENSION 2/25/2022 FAILURE TO THRIVE SYNDROME, ADULT

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Patient Is a 54-year-old female with a past medical history of COPD on 2 L nasal cannula chronically, HFpEF, hypertension, hyperlipidemia, hypothyroidism, GERD, IBS who presents with shortness of breath and wheezing. Patient states that last week her mother was admitted to the hospital with COVID-19. She picked her mother up from the hospital upon discharge and had to spend some time with her to help care for her. She received a DuoNeb as well as Decadron in the ED, ultimately able to be weaned down to 2 L however she still had significant wheezing. She had a CT chest which is negative for PE though she does have right middle lobe attenuation of the bronchial tree consistent with a superimposed pneumonia. Lab work in ED is otherwise unremarkable. She did test positive for COVID-19. Patient states she is vaccinated and has received 2/3 boosters. Patient is admitted to surgical unit for acute on chronic hypoxia, COPD exacerbation and COVID-19 infection. Clinical Summary Patient was treated with decadron and remdesivir for COVID-19 as well as Azithro. Patient's breathing improved to where she no longer needed oxygen and wasn't wheezing. I discussed with the patient, she should receive 3 doses of Remdesivir to prevent progression of COVID since she is at high risk. Patient states though she has to get home to take care of her husband. Will DC with short decadron taper and 2 more days of Azythromycin. Patient has inhalers at home. Patient instructed to return if she wheezes and to isolate for 10 days. Discharge diagnosis COVID-19 Infection

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11/14/22 presents to ED for "shortness of breath". PMHx of "hypertension, HFpEF LVEF 60, ESRD on HD (Monday, Wednesday, Friday), chronic anemia"

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I woke up with a scratchy throat and throughout the day I started to feel fatigued. By that evening I had a fever about 99 or 100. Next morning I just felt a little icky, as the day went on I became more fatigued and the fever came back, definitely over 100. The day after that I went to an urgent care, thinking it was a sinus infection. They tested me for COVID-19, test came back positive. They weren't able to prescribe anything due to my current medications. I went home to isolate as best I could. Wore a mask whenever I left my room, and was able to mostly stay in my master suite but the rest of my household did end up coming down with it as well. I was still feverish off and on for a few days, definitely had a headache. Never lost my sense of taste and smell, but at some point my sense of taste was lessened. It was probably a good week that I isolated, after the symptoms had cleared up I started having issues breathing and had to use my inhaler more.

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Developed rash within 12-24 hours of getting vaccine. About 8 months after getting my vaccine I contracted COVID. Began as a sinus headache and turned into a migraine that lasted 5 days. Mild fever 99 degrees, body aches, nausea, swollen throat and difficulty swallowing. Lot of coughing and congestion. Around day 3 I developed hives similar to what I had when I received vaccine. Around day 5 I reached out to allergist because I was beginning to show signs of a sinus infection. Most symptoms lasted one to two weeks with cough persisting for four weeks.

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12 days after receiving my first booster shot, I developed significant stiffness, pain and decreased strength and range of motion in my right hand. I woke up that evening and on making a fist, my pinky locked and clicked when it did bend. My right hand was very stiff and sore (4/10). These symptoms have continued and are still present. I have decreased strength and range of motion in the right hand daily and extreme stiffness with pain after inactivity (at night or after naps). I had no arthritic symptoms prior to this and symptoms are not getting better. I have slight stiffness in left hand.

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chest pain, abdominal pain, arthralgias

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chest pain

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Breakthrough COVID infection. Sympoms of shortness of breath, mild congestion, and productive cough. Unsure of onset of illness. Positive COVID test collected 08/18/2022

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Discharge Physician: MD Primary Care Clinician at Discharge: Admission Date: 6/9/2022 Discharge Date: 6/11/2022 PRESENTING PROBLEM: Orthostatic hypotension Generalized weakness COVID-19 virus infection HOSPITAL COURSE: 69-year-old woman with chronic systolic heart failure (EF 23%), ischemic cardiomyopathy, coronary artery disease with ICD, mitral regurgitation (severe) and CKD stage 4 presented to the hospital with generalized weakness. She is found to be orthostatic we positive and was given judicious fluid boluses in the emergency department given her heart failure. She remained orthostatic and symptomatic and thus was admitted to the medical service. COVID-19 testing was positive though she was asymptomatic and without hypoxemia on ambient air. Review of medical records revealed that she was on hydrochlorothiazide/spironolactone/torsemide as well as lisinopril as prescribed by a Heart Clinic. These medications were held and the patient was provided very judicious IV fluid hydration overnight. Cardiac monitoring revealed no acute malignant arrhythmias. Electrolytes were within normal limits and creatinine was at baseline. Her symptoms did resolve. Measured orthostatic vital signs did reveal resolution of orthostatic hypotension. She was discharged on 06/11/2022. She was instructed to hold hydrochlorothiazide until her next visit with a Heart Clinic. She was discharged in good condition.

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Pt to ED 5/7 c/o sickle cell crisis, with pain to both arms and right leg. COVID+ 5/7, No other respiratory symptoms, not a candidate for antiviral therapy for COVID-19 infection. 5/8 Pt states he is having more pain in his arms. It is hard for him to lift them. 5/9 pt has remained AO x 4 throughout shift. No complaints of pain or weakness. No COVID-19 symptoms. Pt discharged 5/10.

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aspiration pneumonia after testing positive for covid 5/22/22

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ED visit (5.6.22); Hospitalized w/ COVID (5.8.22); COVID-19 positive (5.1.22 / 5.8.22); Fully vaccinated PLUS two boosters. BRIEF OVERVIEW: Discharge Provider: Primary Care Provider: Admission Date: 5/8/2022; Discharge Date: May 13, 2022; DETAILS OF HOSPITAL STAY:PRESENTING PROBLEM: Hypoxia [R09.02]; Pneumonia due to COVID-19 virus [U07.1, J12.82]; COVID-19 [U07.1]; HOSPITAL COURSE: Pt is a 78 yr old F with PMHx of chronic hypoxic respiratory failure on 8L via NC at baseline, COPD, CAD, CHF, A-Fib, HTN, HLD, depression, OSA and obesity, presented to the ER on 5/8 with c/o worsening dyspnea. She is fully vaccinated, tested positive on 5/1 for COVID-19 and received molnupiravir (an antiviral) on 5/3 as outpatient. However, she continued to experience fatigue, hypoxia which prompted her ED visit. In the ER, she was borderline febrile, normotensive, tachycardic and tachypneic, maintaining appropriate oxygen saturations on 15 L/min NRB mask. Initial venous gas showed normal serum pH with likely chronically elevated pCO2 of 56 and bicarbonate of 30. Other initial labs show stable renal dysfunction, elevated proBNP, normal procalcitonin, normocytic anemia, and her COVID-19 screen is again positive. EKG showed A-Fib with RVR. CXR shows patchy bibasilar opacities suggestive of atelectasis vs infiltrate/pneumonia without significant interval change from imaging 2 days ago. Admitted for further management - started on Decadron x 10 days, Remdesivir x 5 days for COVID-19 PNA. There was concern for superimposed bacterial infection - Pulmonary consulted and empiric IV Cefepime/Doxycycline initiated. Sputum cultured attempted but unsuccessful. Clinically - her symptoms improved with return to baseline of her oxygen demands. On 5/11 - patient had left shoulder pain while attempting to move in bed. X ray concerning for left shoulder dislocation. Ortho consulted - felt it was chronic left rotator cuff tear with plans for outpatient follow up. PT/OT recommend Home with assist and home health. She was transitioned to oral Ceftin/Doxycyline for 3 more days to complete a total of 7 days of Antibiotics, as well as Decadron for total of 10 days. We reviewed stopping Amlodipine and reducing Lisinopril to 10 mg once daily as blood pressures well controlled in the hospital. Also discussed resuming Azithromycin daily once completion of current antibiotics - patient and son voiced understanding. She is discharged on 05/13/2022 in stable condition.

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Early Morning April 28.2022. I had woken up in the middle of the evening to use the restroom. Probably between 430 and 530am. At some point I believe I fell and hit my head on the counter. I had goose eggs on the right side of my head and there were things knocked off of the counter with pain on the right side of my body. My son came to wake me up because I hadn't woken him for school. He struggled to wake me and was finally able to call my mother who looked me over. When she arrived, I wasn't able to form full sentences and was struggling to get even one word out. She ended up taking me to the ER after calling my OB. Once we got to the ER they did a urine sample and blood work and a mental evaluation to rule out a stroke. They were concerned specifically about my inability to speak properly which lasted from about 9am-2pm that day. My speech ability gradually returned and improved from one word at a time to full sentences. They also did a CT scan for blood bleeds and monitored my blood pressure which was high. But they attributed that to nerves. They then sent me to labor and delivery for monitoring of the baby. The baby seemed fine and was moving as expected. The doctor came in and mentioned seizure activity and suggested that I see a neurologist. I had an appointment after that with a doctor and am waiting on an appointment with the neurologist. I haven't had any other episodes but have had moments of dizziness that pass after resting for a bit. I am also monitoring my blood pressure regularly. 20 weeks pregnant at time of adverse event. Estimated due date September 13, 2022.

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cough, shortness of breath

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COVID breakthrough. The first 2 weeks of infection I had runny nose, headache, cough, tiredness. The following 3-4 weeks I developed long COVID symptoms which included, extreme fatigue, nausea, shortness of breath, and increased heartbeat. I am still experiencing some of the symptoms until this day.

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After the first injection, my migraines went from approximately 1-2 a month to 15--18 a month. Subsequently, I have been unable to hold down a job, participate in life, attend church or spend quality time with my family. I spend half of a month in a dark room, in bed, alone and away from my entire family. Sometimes I get an aura as a warning that my migraines are about to come on, sometimes I just get intense pressure immediately. My general practitioner and neurologist have tried to help me with multiple medications, but nothing seems to work. My chronic migraines typically last 1--2 days.

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Itching and hives all over body, pneumonia.

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Day 1: Red, small hard knot, feverish to touch Day 2: Larger knot, sill feverish Day 3 - 6 Vertigo - unable to walk/care for self/nauseated--stayed in bed and with meds slept majority of time slept and unable to remember what was going on--could not move head without getting dizzy (vertigo) Day 7 - 10: Vertigo seemed better/improving, but still dizzy Day 11: Vertigo better/swelling gone All the while breathing difficulty and that continues through this date/tired when gets up to do anything//concerned about permanent damage as well as blood sugars

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Site: Pain at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-, Additional Details: Patient states sharp pain at injection site immediately after vaccination. He was told pain would go away in 2-3 days, but hasn't resolved. He didn't take any pain meds at the time, but dr has advised on ibuprofen and possible further testing. States administration of vaccine felt like stabbing motion.

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I'm experiencing continued tingling/burning sensation on my arms (i believe referred to as paresthesia). It has been present for the past few months, which aligns with when I got my booster shot. Initially it was primarily at night, disrupting sleep, but now it often persists all day long. It is worse in my left arm, but present in both.

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5 minutes after my 2nd dose vaccination, I experienced the following: shortness of breath, flushed face, chills, nausea. Overall I experienced these symptoms for 3 days.

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1/9 Was walking thru a new house and started feeling weak and short of breath. And got quickly worse with shifting and later felt like I was on a boat(Vertigo) When I kept my head still it was fine but if I moved my head in the slightest it started again swaying. I asked to go to urgent care and I never ask to go see a doctor always saying it will pass. When I got there I got Xray, physical, blood and urine and when I was checked by moving my head I got REALLY DIZZY and the room itself seemed to be spinning fast. Was given meclizine for treatment and was advised ENT. I was taking the meclizine on and off since but it seems to be tapering off. Went to see my PCP but he was out of office and was seen by the PA. Only had a physical and agreed that I needed to see an ENT. This will happen on 1/26, and still dealing with vertigo.

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Onset of heart palpitations with tachycardia, SOB, and left sided chest pain approximately 12 hours after vaccination. Additional symptoms: body aches, fatigue, dizziness, headache, chills, severe pain at injection site. I assessed my own vital signs using my fitness watch and resting heart rate remained between 105-110bpm, blood pressure < 120/80mmHg and my SpaO2 remained at or above 97%. After 12 hours of symptoms that were not subsiding I self treated with 400mg OTC ibuprofen and approximately 3 hours later all side effects resolved resting heart rate returned to my baseline of 55-60bpm.

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After my first dose (04/1/21), my right arm where I got the vaccine became red and itchy 9 days after my vaccine, it lasted for a day, then went away. I didn't have the same "Covid arm" reaction after my second dose, though I had swollen lymph nodes in my armpits and was very ill for a few days. I have had hives everyday since 8 days after my booster shot (12/04/21) as well as swollen lymph nodes in my armpits. A close friend has had the same issue, 10 days after receiving the Moderna vaccine - persistent hives and swollen lymph nodes that have lasted since then.

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Swollen glands behind the ear at the jaw line, severe chest pain and heart palpitations, fluttering accelerated pulse. Further testing required. X-rays reveal possibility of a swollen heart valve. Patient has no history of heart problems.

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Dec 23 evening - experienced itchiness on head and arms Dec 24 morning - woke with allergic reaction symptoms -> severe itchiness/hives on torso, arms and head, acid reflux, shortness of breadth, low energy, took over the counter Benadryl every 4 hours throughout day, symptoms got better Dec 25 morning - woke with allergic reaction symptoms -> severe itchiness/hives on torso, arms and head, acid reflux, shortness of breadth, low energy, took over the counter Benadryl every 4 hours throughout day, symptoms got better Dec 26 morning - woke with allergic reaction symptoms at 1am -> severe itchiness/hives on torso, arms and head, acid reflux, shortness of breadth, low energy -> went to The local hospital ER, administered steroid, Zyrtec and Pepcid and released Dec 26 day -symptoms got better up until 2pm then declined again Dec 27 morning - woke with allergic reaction symptoms at 1am -> severe itchiness/hives on torso, arms and head, acid reflux, shortness of breadth, low energy -> administered Epi pen for tree nut allergy, went to The local hospital ER, administered steroid, Zyrtec and Pepcid and released Dec 27 day - prescription picked up for aforementioned medicines, started that during the day symptoms improved Dec 28 day - saw primary care -> no confirmed diagnosis, symptoms NOT for food allergy, suspect symptoms from Moderna booster shot administered on Dec 14, did blood work Dec 29 day - blood work indicated possible blood clot and infection Dec 30 evening - had CT scan of torso performed -> no blood clots Dec 31 - Jan 5 - symptoms are hives on skin on arms and head when irritated or scratched, shortness of breath at times, acid reflux at times, elevated resting heart rate ~80bpm (typically 60), lower energy level

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Within 24 hours of the 3rd dose, (Booster), I developed fever, chills, shortness of breath and headache. Between 24-48 hours after, I became very lethargic and confused. I do not remember Tuesday 12/13/21 at all. I was hallucinating and not acting normal according to my wife. Starting on Wednesday 12/14/21, I began to have substernal chest pain, fluctuating in pain throughout the day with increased headaches and tachycardia. The chest pain has been increasing everyday and the tachycardia happens multiple times a day now unprovoked. With the tachycardia i get short of breath and dizzy. On Wednesday 12/23/21, the pain in my chest with the tachycardia was to the point that I went to Emergency Room. I have had a follow up with my PCP on 12/29/21 and now have an Echocardiogram scheduled for 1/6/22. I continue to have tachycardia throughout the day with palpitations that are only increasing in pain and duration. I never had these issues prior to my Covid Booster. Nothing in my medical history has changed in the past year.

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10 days after receiving my COVID-19 booster shot (Moderna), I developed urticaria (hives) on different areas of my body. It started with my head feeling itchy around 6:00 p.m. on 12/15/2021. 12 hours later I had hives on my torso, arms, legs, back, neck, etc. Over the next 5 days I continued to have horribly itchy hives that moved to different areas of my body. My hands and feet became extremely swollen for 2 days due to the hives and my itching. I went to urgent care on 12/16/2021, and they prescribed me Claritin, Benadryl, and Methylprednisone. These were not helping much. I went back to urgent care, and then they sent me to the ER, on 12/19/2021 because I started to feel worse (hives persisted, some chest pain and trouble breathing, and extremely swollen hands and feet). They prescribed me Pepcid and Claritin. They did some tests at the ER but did not determine a cause for any of my symptoms. I was at the ER for about 8 hours. On 12/20/2021, I went to a dermatologist, who prescribed me higher doses of Zyrtec, and Prednisone to take once I finished the Methylprednisone. Now since 12/21/2021, I have had less hive breakouts, and the last day I had any hives was 12/26/2021 around 4:00 a.m. I am still taking medications. Also to note, I have no known food allergies or allergies to substances (lotions, beauty products, etc) and had not eaten or started using anything new around the time my hives started. My only known allergy is amoxicillin.

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Very sore left arm, hurts when I move it. Tender arm. Sore throat, migraine, chills, body aches.

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Severe vomiting for 2 days, unable to rise from bed for 4 days, chills, no fever

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Received Moderna Booster on 12-7-21. Symptoms of hives began to appear on 12-14-21. The hives started on my scalp and neck. The past week the hives have worsened. I have developed dermatographia (skin writing) and will get hives for 10-40 minutes on any location that is scratched. Seams of clothing will also trigger hive development.

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Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Flushed / Sweating-Medium, Additional Details: Metallic taste in mouth

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Nausea and chills began 9 hrs after dose, vomiting began 15 hours after dose and lasted for 3 hours. Chills and nausea abated after 24 hours, swollen and painful armpit began 36 hours after dose and continues currently at 48 hours post-dose.

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PATIENT STATES HE HAD A SEVERE REACTION TO HIS BOOSTER SHOT. HE INITIALLY HAD JOINT PAIN THE EVENING OF THE VACCINE. HE THEN WORSENED OVER THE NEXT DAYS TO HAVE CHILLS, FEVER, ACHES, LOSS OF APETITE, NAUSEA, VOMITING, DEHYDRATION WITH DARK THICK URINE (LIKE HONEY). THOSE SYMPTOMS LASTED APPROXIMATELY 3 DAYS AND THEN HE BEGAN TO RECOVER. ON 12/13 HE REPORTED THAT HE BEGAN FEELING ITCHY ON HIS ENTIRE BODY. HE REPORTED TAKING TYLENOL AND IBUPROFEN AND DRINKING LOTS OF FLUIDS. I ADVISED PATIENT TO SEEK TREATMENT.

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Systemic: Body Aches Generalized-Medium, Systemic: Dizziness/Lightheadedness-Medium, Systemic: Exhaustion/Lethargy-Medium, Systemic: Hypertension-Severe, Systemic: Tachycardia-Medium.

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Chest pain, irregular breathing, heart rate skipping, fast heart rate and fatigue. The time course was from 8pm on 12/13/2021 until now at 3:41pm on 12/14/2021.

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Site: Pain at Injection Site-Severe, Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-

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about 24 hrs after vaccine (12/8, evening) - chest pain (left upper chest), rather severe at times, difficulty expanding chest, some shortness of breath. Some pain into left arm. Subsided later that evening. Some achiness in chest Thursday 12/9 Friday 12/10 - chest pain seemed to return, more localized to just left of sternum. Pain with expansion of chest and some shortness of breath.

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Systemic: Headache-Medium, Additional Details: Patient reported a headache tingling sharp pain in the back of her head. We asked her to wait for further observation. She said she was fine after 15 min and left

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Patient received vaccine at 6:15 and reported not feeling well at 7:00--described tingling tongue, off balance , and light headed. At 7:05 she said her tongue felt fat and she was having trouble walking due to balance uncertainty. I gave her diphenhydramine 50mg intramuscularly at 7:10. She reported she was going to pass out and was very shaky . I called 911 and reported adverse reaction. Ems Arrived and checked vitals and gave her the option of going to hospital but said she was feeling better. i monitored her until 7:25 and her son picked her up but returned when they got to the front door because her tongue was swelling again. She reported she could not breathe and I injected epinephrine .3mg into outer thigh and had coworker call 911. was transported to Hospital. At 9pm she was still under observation but feeling better.

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Systemic: Chest Tightness/Heaviness/Pain-Medium, Systemic: Hypertension-Medium, Additional Details: Patient got a booster of Moderna. His first 2 doses were Pfizer. After the booster was administered he experienced chest tightness, which he described as feeling like having anxiety but he was not anxious. His blood pressure was 146/97. He said his baseline is high but was not sure of the level. He experienced this for about 2.5 hours and is now completely back to normal everyday activities.

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Heart palpitations

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Pt received her booster dose of Moderna on 12/1/21. She called Health Department on 12/3/21 to report a few hours after her booster shot she started experiencing some numbness and tingling around her left eye and left side of her mouth. Pt reports she did not notify her primary care doctor or seek emergency evaluation. Pt reports she still feels like she had lidocaine around the left side of her face. Public Health Nurse advised pt she needs to seek urgent evaluation right away. Pt verbalized understanding and agreed to the plan of care. Public Health Nurse tried to call pt back on 12/7 for follow up however while on the phone the pt said she had to go abruptly since she was at work. Pt did state was still experiencing some of the same symptoms but they seemed to be improving.

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48 hrs * Cold Chills * Stomach Spasms * Nausea * Dizziness * Loss of balance * Confusion * Fatigue * Muscle & headaches * Palpitations * Sore injection site

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PATIENT COMPLAINED OF FACIAL TINGLING AFTER 15 MINUTES OF RECEIVING THE VACCINE. 25 MG OF DIPHENHYDRAMINE WAS GIVING ORALLY. PATIENT USED THE RESTROOM AND THEN LEFT AT 2:10PM STATING "SHE IS FINE"

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Moderate injection site pain, worst at 6-7hrs after injection, improving by 9am the next morning. Chills, night sweats, headache, myalgias, nausea started at 4am. All except headache resolved by 9am the next morning.

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Bilateral hand numbness and night pain--medial nerve sx saw orth and primary MD symptoms persist

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I have received 2 booster shots, both the Moderna brand. While I had no significant reaction to either of my initial doses, I think I may be allergic to the booster. My first booster was on 12/27/21 and starting 1/7/22, exactly 2 weeks after, I began having a reaction that consisted of painful and itchy hives all over my body that didn't respond to anything and lasted consistently for about a month following. My second dose of the booster was on 4/11/23 and starting 4/25/23, also exactly 2 weeks later, I developed painful and itchy hives that have not responded to anything. With still being in the presumable month if this follows the first time, I don't know how long it will last.

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Fever over 103 for over 48h Joint redness, tenderness, swelling at 72h (hands and knees with difficulty walking stairs, and I am active) Balance distortion Severe redness with swelling of entire upper L arm, dark reddened area, extremely tender, has appeared adjacent to inj site Axillary lymphadenopathy

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Tested positive 08/08/2022 - I had chills with a fever. A headache, sore throat and body aches. Tested positive again 11/07/2022 - I had a headache, a sore throat and mild body aches.

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Started having a sore throat and stuffy nose and little cough. It didn't really get much worse than that. I waited a day I took an at home test and it was negative, but my wife had already been diagnosed with COVID-19. I then went to a clinic and after I got the positive reading a telehealth was scheduled. I was then prescribed PAXLOVID the symptoms didn't get any worse and by the time the medication was gone I had no more issues.

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positive covid test in fully vaccinated, boostered, symptomatic pt

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I woke up not feeling well before going to work so I tested before going to work as I did I have flu like symptoms. I consulted with my doctor which changed the course of my prenatal care.

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Acute pancreatitis Hospitalized for 2 days Abdominal pain - worsened upon eating Chronic Pancreatitis May 2022

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fatigue, cough, myalgias, headaches, chest tightness

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Moderna Dose 1 2/19/21 (023M20A) Moderna Dose 2 3/19/21 (026A21A) Moderna Dose 3 12/15/21 (029H21B) COVID Positive 2/5/22 2/5/22: 68-year-old male patient with a history of muscular dystrophy, hypertension, s/p pacemaker placement several years ago is wheelchair-bound at home. There is a caretaker who helps him. Patient has been constipated for more than 2 weeks. He has had very little flatus. His abdominal pain has been slowly getting worse. Patient has had some nausea and only 1 episode of vomiting. Since the pain was getting worse, patient came to the hospital for further evaluation. The pain is located in all the quadrants of the abdomen. Patient has not had any bloody stools. He denies any fever/chills associated with abdominal pain. A CT of the abdomen/pelvis shows evidence of significant amount of stool impaction. Surgeon was called from the emergency room for consultation. 2/9/22: 68-year-old male patient with a history of muscular dystrophy, hypertension, s/p pacemaker placement several years ago is wheelchair-bound at home. There is a caretaker who helps him. Patient has been constipated for more than 2 weeks. He had very little flatus. His abdominal pain was slowly getting worse. Patient has had some nausea and only 1 episode of vomiting. Since the pain was getting worse, patient came to the hospital for further evaluation. The pain was located in all the quadrants of the abdomen. Patient had no bloody stools. He denied any fever/chills associated with abdominal pain. A CT of the abdomen/pelvis shows evidence of significant amount of stool impaction. Surgeon was called from the emergency room for consultation. Patient had manual disimpaction of the stool on 02/05 per surgery in the OR. Patient was also noted to have rectal colitis and started on Levaquin and Flagyl. Patient subsequently was able to have bowel movements without difficulty. Patient also had perirectal fissure, wound nurse was consulted. Patient was also tested positive for SARS-CoV-2 infection but he was totally asymptomatic and was not placed on any oxygen. He did not require any treatment with remdesivir or dexamethasone as he did not complain of any shortness of breath. His electrolyte abnormalities were corrected. Patient was stable at the time of discharge. He was discharged home with VNA. He will complete the course of antibiotics as prescribed for treating rectal colitis. I did discuss with the patient's caregiver and all questions were answered. Patient will follow-up with primary care physician in 1 week. Patient was advised high-fiber diet and stool softeners advised to be continued to prevent is further episodes of severe constipation.

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Breakthrough covid case. Presented to ER with c/o of bilateral ear pain, nasal congestion, sore throat, body aches, cough and exposure to covid. Hx of Moderna vaccine x 3. Prescribed Paxlovid. DC home.

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I now I got a COVID from a party. My symptoms started 2 day after the party. I was weak with body ache. I tested at home and was negative. I tested two days later and was positive. During the sickness I took day quill and night quill. I developed hives and heart complications, post viral reaction. I take prednisone for the hives. And I take hydro steroids' for the hives.

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I started getting a sore throat, congestion, cough and fever. I decided to test after my son also came down with symptoms and we had been on a two road trip. I used went to a pharmacy clinic and had a PCR COVID 19 test that came back positive. I was told to quarantine for fourteen days.

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Breakthrough COVID-19 case: When I woke up my throat was hurting and experienced congestion. Also felt feverish and had body aches. My kidneys felt sore and achy. I had cough, brain fog and fatigue. I took a rapid test and it came back negative. I felt a little better the next day but decided to test again and it still came back negative. I took some Ibuprofen and cough syrup on both days. On Monday 06/06/2022 I still wasn't feeling better so I went to Urgent Care and had a rapid test and a PCR test and I got my results back on 06/08/2022 and it showed I was positive for COVID-19. I was given Claritan D and cough syrup. I'm starting to feel better.

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I had mild symptoms -- just tiredness and sore arm for a few hours following vaccination. I did not get COVID until 6 months after this dose.... I was very sick for 2 days -- cough, head ache, aching muscles, chills. Day 3 was very tired and cough remained for 7-10 days getting gradually better each day.

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5/17 s/p fall, weakness, fatigue, presented to Emerg. center on 5/20 w weakness, fatigue, and back pain. home test positive for covid on 5/19, tested at hospital PCR on 5/20. Was prescribed Paxlovid on 5/19-5/24 as op, Unclear if actually given. in hospital treated w decadron and remdesivir

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Up to date with vaccination admitted to hospital with symptomatic COVID

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