Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection, White blood cell count increased
Clinical narrative: COVID Vaccine Breakthrough Case  Pfizer Dose 1 3/1/21 (lot not listed in online system) Pfizer Dose 2 3/30/21 (EN6207) COVID Positive 10/1/21  10/5/21: Patient is a 74-year-old male who tested positive for COVID-19 on 9/30/2021.  He presented to the emergency department today with complaints of increasing shortness of breath, dyspnea on exertion, cough, and nasal congestion. He was noted to be 83% SpO2 on room air.  He was placed on 3L of supplemental oxygen which has kept him greater than 90% SpO2.  He was also noted to have a fever of 101.3° F.   His labs were significant for AST 59, PO2 56, WBC 14.34, but were otherwise unremarkable.  D-dimer was negative when corrected for age.  He had a chest x-ray which suggested viral pneumonitis.  He had a CTA chest which showed ground-glass infiltrates in both lungs consistent with viral pneumonitis, but no PE.   On arrival to the floor, patient is requiring 3L of supplemental oxygen.  He denies fever, chills, chest pain, palpitations, nausea, vomiting, diarrhea .  Biggest complaint is cough with deep breathing and mild shortness of breath at rest.  Says he is feeling much better now with the oxygen.  10/10/21: Patient is a 74-year-old male who was admitted on 10/5/2021 with acute hypoxic respiratory failure, secondary to bilateral COVID pneumonia.  He also had elevated LFTs secondary to COVID and leukocytosis secondary to recent corticosteroid use.  The patient was admitted to the medical floor.  He was started on Remdesivir, Levaquin, and dexamethasone.  He also reported a significant cough, so he was started on Robitussin AC which seemed to help.  His blood cultures have had no growth to date.  He was not able to provide a sputum sample.  He completed his remdesivir course yesterday evening.  He reports today that he is feeling much better.  He is asking to go home.  He denies chest pain or palpitations.  Denies shortness of breath at rest, but does report some dyspnea on exertion.  His oxygen need has significantly improved.  He is currently on room air at rest, but requires 3L by nasal cannula with activity, per the home oxygen walk this morning. Patient is being discharged home with home nursing services for nursing and respiratory therapy due to his need for home oxygen.  He is also being discharged with the at Home COVID care program.  They will follow-up with him after discharge.  He should continue dexamethasone 6 mg p.o. daily x5 days, Levaquin 750 mg p.o. daily x3 days, and Robitussin AC 10 mL p.o. t.i.d. a.c. p.r.n. cough.  His self-quarantine is complete today.  He should continue with home oxygen, on room air at rest, 3L by nasal cannula with activity.  He should follow-up with his primary care provider in 1-2 weeks.  I recommend a chest x-ray in 4-6 weeks to document clearance.  The patient has been provided education for COVID pneumonia, home oxygen, Robitussin AC, dexamethasone, and levofloxacin.  I have answered all of his questions and addressed all of his concerns.  The patient is being discharged in improved and stable condition.