Age: 73.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Hypokinesia, Hypotension, Hypoxia, Livedo reticularis, Malaise
Clinical narrative: 73 y.o. female with a past medical history of non-insulin-requiring diabetes type 2 and recent admission at Hospital (5/31-6/6/2021) who was transferred on 6/9 for chest pain with worsening EF with concerns for ischemic cardiomyopathy.    Hospital course by dates 5/31?6/6/2021: Admitted for abdominal pain, nausea and vomiting thought to be secondary to ischemic colitis and severe constipation.  Patient was found to be anemic during that hospitalization, but did not require blood transfusion.  Patient's hospital course was complicated by aspiration pneumonia requiring PICC placement and norepinephrine.  She is no longer requiring supplemental oxygen was discharged home. 6/9: Return to hospital with increasing shortness of breath, confusion and generalized malaise.  Repeat TTE with anterior wall motion abnormalities and decreased EF.  Patient was transferred to bed for cardiology evaluation 6/10: Cardiac catheterization with moderate three-vessel coronary disease, wall motion abnormality does not correspond to coronary disease.  Cardiology thinks findings are related to stress-induced cardiomyopathy.  6/11: Patient continues have downtrending hemoglobin, started to prep for colonoscopy on 6/12. 6/12: Rapid response was called at at approximately 4:40 AM, patient ultimately expired at 7:35 AM   Patient was transferred from Hospital given new wall motion abnormalities and severe hypokinesis seen on repeat TTE.  Fortunately, cardiac catheterization on 6/10 without coronary artery disease that corresponded to these wall motion abnormalities.  Ultimately, it was thought to be stress induced cardiomyopathy.  Patient was improving, but still complained of epigastric discomfort.  Given her recent diagnosis of ischemic colitis and ongoing abdominal pain, GI was consulted for EGD/colonoscopy on 6/12   Rapid response was called at at approximately 4:40 AM.  They were mottled appearing, hypotensive and cool to touch.  Patient was found to be severely hypoglycemic and had wide-complex tachycardia.  Multiple amps of D50 were given but remained hypoglycemic. Patient was also found to be hypoxemic and did not tolerate BiPAP.  Eventually patient was transition to comfort measures only.  After discussion with patient's daughter, patient's last 10 minutes of life consisted of "fluid pouring out of her mouth".   Work-up also was positive for elevated lactic acid and elevated D-dimer.  Given the abrupt change in patient's clinical status, concern for embolic thrombosis is the most likely cause.  Unclear if had pulmonary embolism or ischemia to gut.  Interestingly, patient was visiting her from Indiana for her brother's funeral.  After discussion with family, patient's brother had a similar unexplained death just a few weeks prior.  The Family going back to the fact that she had her second Maderna vaccine 3 days prior to presenting to select hospital.  Patient's brother also had a Maderna vaccine before his recent demise.   Given the unknown cause of death, an autopsy was discussed with family.  They were agreeable to this.  Highly concern for thrombotic event, but unable to confirm at this time without autopsy.  Unknown if recent vaccine was related to her death, but could explain thrombosis leading to ischemic colitis prompting her last admission.  Patient was noted to have a "severe" reaction to her first vaccine.