Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Chest pain, Colonoscopy normal, Computerised tomogram head normal, Culture negative, Dyspnoea
Clinical narrative: COVID Vaccine Breakthrough Case  Pfizer Dose 1 2/26/21 (EN6198) Pfizer Dose 2 3/19/21 (EN6207) COVID Positive 12/22/21  12/22/21: Patient is a 71-year-old female who originally presented to the emergency room with some chest pain symptoms and went on to develop some shortness of breath and dyspnea.  Along with this the patient had noted several days of her stools being dark black in color with no bright red blood per rectum.  No fever, chills or night sweats are noted with no abdominal pain complaints.  Patient denies any recent changes to her medical regimen and denies any recent travel.  Patient does have recent exposure to COVID-19 yesterday with a family member that has tested positive.  At the time the patient was seen at the bedside she is currently denying any chest pain symptoms but does endorse some ongoing shortness of breath and dyspnea. Patient had denied any hematuria, hemoptysis or hematemesis.  Patient's medical history, current medications, imaging studies, vital signs, laboratory data and emergency room records were personally reviewed.  Case was also discussed directly with the emergency room provider.  Repeat chest x-ray was also discussed reviewed which showed significant worsening versus the initial chest x-ray and may have been related to fluid overload given the patient's history of severe heart failure with her last ejection fraction being 35-40%.  12/31/21: Patient is a 71-year-old female with past medical history of CAD, type 2 diabetes, hypertension, history of PE, hyperlipidemia, hypothyroidism, dextrocardia situs inversus, Chronic HFrEF presented to the ED on 12/22/21 with shortness of breath, chest pressure and complained of dark stools.  Patient admitted for acute hypoxic respiratory distress secondary to COVID-19 pneumonia, acute metabolic encephalopathy, new AKI, concern for upper GI bleed and and NSTEMI.   - CT head negative.  Encephalopathy resolved.  - There was a concern for NSTEMI, Cardiology was consulted and the thought was patient is elevated troponin was secondary to acute anemia.  Recommendations for patient to follow up with Cardiology as outpatient.  - Patient presented with a hemoglobin 6.6 and receive 2 units RBC.  Hemoglobin has remained stable.  Patient had EGD and colonoscopy without acute finding.  Patient will need to follow up with GI for biopsy results.  Given patient's extensive cardiac history Will continue aspirin and Plavix, the risk extensively reviewed.   - Patient also tested positive for COVID-19.  The patient did require supplemental oxygen however shows wean to room air.  Cultures negative.  Patient did not receive remdesivir due to renal function.  Patient completed antibiotics.  Patient will be discharged on Decadron.   - Patient also noted to have acute kidney injury. Nephrology was consulted.  Nephrotoxic medications was discontinued.  Renal function did improve.  Foley has been removed patient has been able to void.  Patient will follow-up with PCP or Nephrology as needed.   Precautions return to the ED extensively reviewed with patient and family at the bedside, they have verbalized understanding.