Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Productive cough, SARS-CoV-2 test positive, Vaccine breakthrough infection, Ventilation/perfusion scan normal
Clinical narrative: COVID Vaccine Breakthrough Case  Pfizer Dose 1 3/18/21 (EN6205) Pfizer Dose 2 4/16/21 (Er8732) COVID Positive 11/5/21 Admitted to hospital 11/5/21-11/7/21  11/12/21: Patient is a 72-year-old female with a past medical history significant for type 2 diabetes, hypertension, GERD, hyperlipidemia, obesity, chronic ischemic heart disease.  The patient presents to the ED today with complaints of shortness of breath.  The patient tested positive for COVID-19 on 11/05/2021.  The patient was subsequently admitted to the hospital on Sunday evening 11/06/2021 and discharged on 11/07/2021 on 2 liters of home oxygen, she states she was not on any oxygen prior to admission to the hospital.  The patient states she received steroids while inpatient, did not receive any antivirals or convalescent plasma.  The patient states she did received convalescent plasma yesterday as an outpatient.  The patient states she woke up this morning was unable to catch her breath despite being on 2 L of oxygen via nasal cannula, her pulse ox symmetry was 87%. She denies any chest pain, fever, chills, loss of appetite, diarrhea.  Patient's accompanying symptoms include productive cough.   Upon arrival to ED patient's temperature is 97.3°, heart rate 62, respirations 22, pulse ox 90% on 2 L oxygen via nasal cannula, blood pressure 118/71.  The patient's oxygen was increased to 3 L and her oxygen saturation increased to 97%. Patient's chest x-ray reveals bilateral pulmonary infiltrates.  V/Q scan was completed in is normal. Patient's laboratory findings are significant for glucose 119, D-dimer 2.71.  Patient received 500 mg IV azithromycin, 2 g IV Rocephin, 6 mg IV Decadron in ED.   The patient was seen examined at the bedside in the ED. The patient states she continues to feel short of breath despite O2 saturations being 97% on 3 L oxygen.  The patient denies any previous history of lung conditions or shortness of breath.  Patient is vaccinated against COVID-19.  Patient denies any tobacco use, drug abuse or alcohol abuse.  11/16/21: A 72-year-old woman who had presented to the emergency room with worsening shortness of breath.  Patient recently diagnosed with COVID-19 after testing positive on 11/05/2021, she was admitted at Hospital on 11/06/2021 and discharged on 11/07/2021 on 2 L of oxygen.  Due to persistent symptoms, patient presented to the emergency room.  She was admitted for COVID-19 pneumonia and acute hypoxic respiratory failure.  Inflammatory markers where elevated.  Patient was started on IV remdesivir, empiric antibiotic therapy with ceftriaxone and azithromycin.  She is on IV dexamethasone.  She developed bradycardia remdesivir, this was discontinued.  She was continued on oxygen.  She had aggressive pulmonary toileting done.  Urine cultures returned positive for E coli sensitive to ceftriaxone.  Patient reports improvement in her symptoms, she is occasionally on room air, also requiring 2 L of oxygen.  She is stable and being discharged home in a stable condition.  For outpatient follow-up with PCP, can probably be weaned off oxygen in near future.