Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Blood albumin decreased, Blood alkaline phosphatase increased, Blood calcium decreased, Blood glucose normal, Blood magnesium decreased
Clinical narrative: Pfizer Dose 1 3/2/21 (EN6200) Pfizer Dose 2 4/2/21 (ER8734) Pfizer Dose 3 9/16/21 (EW0177) COVID Positive 12/2/21 (pt reported) COVID Positive 1/31/22  1/31/22: Patient is a 67-year-old male with a past medical history significant for follicular lymphoma, depression, hypertension, hyperlipidemia, former smoker. The patient presents to the ED today with complaints of generalized weakness. He complains of generalized weakness that has been ongoing since the end of November that has worsened over the last few days.  He was apparetly seen by his visiting nurse today who found that he was tachycardic and had a low pulse ox level.  The patient states he had COVID-19 in December 2021 and since testing positive he has never fully recovered. He originally tested positive on 12/2/2021. He states since testing positive in early December his symptoms have not been improving.  He complains that over the last couple of das he has became significantly more weak and states he was unable to ambulate without the assistance of a walker which is not normal for the patients. He states that even with assistance from the walker he was having balance difficulty and difficulty walking distances due to becoming easily fatigued.  His accompanying symptoms include productive cough with green sputum, shortness of breath, weakness, body aches, ore throat, and dizziness. He denies any palpitations, chest pain, nausea, vomiting or diarrhea. The patient is vaccinated for COVID-19 x3. He denies any alcohol abuse, illicit drug abuse or tobacco use. He recently quit smoking in December 2021 when his illness began, prior to that he did smoke 1/2 pack of cigarettes per day.   Upon arrival to ED patient's temperature is 101.8°, heart rate 176, respirations 16, pulse ox 88% on room air, blood pressure 85/54.  The patient was subsequently placed on 15 L oxygen via OxyMask to maintain O2 saturations greater than 90%.  The patient was found to be in atrial fibrillation with RVR, the patient has a known history of this.  The patient received 3 doses of IV Cardizem with some resolution of tachycardia, however patient's blood pressure was low.  The patient was subsequently started on amiodarone per recommendations from Dr., cardiologist.  Patient is currently on an amiodarone drip and Levophed drip due to patient's blood pressure being low.  Patient also received 2 g IV magnesium sulfate, 125 mg IV Solu-Medrol, 500 mg IV azithromycin, 500 mg IV calcium gluconate, 1 g IV Rocephin, 3 L IV normal saline, 40 mEq IV potassium chloride in the ED.  chest x-ray reveals multifocal airspace disease concerning for viral pneumonia/pneumonitis.  Patient's laboratory findings are significant for potassium 3.1, glucose 116, ALT 58, AST 52, ALP 365, total protein 4.1, albumin 2.3, calcium 7.4, magnesium 1.2, phosphorus 2.2, hemoglobin 10.3, hematocrit 31.1, INR 1.4, CRP 8.50, rapid COVID-19 antigen is positive.   The patient was seen and examined at the bedside in the ED. The patient states he feels better than prior to arrival. He admits he has been ill since initially testing positive for COVID-19 in December 2021, however, at that time he did not require inpatient treatment. His biggest complaint is significant and worsening weakness and fatigue that has been ongoing and worsening since December.  2/21/22: Patient was managemend aggressively with broad spectrum IV antimicrobials, vasopressors, cardioversion for atrial fibrillation  He was intubated, extubated however unable to sustain without mechanical ventilation  Despite maximal effort including CRRT and continued mechanical ventilation, multiple vasopressor medications, the patient did not progress in a recovery direction. His clinical status continued to deteriorate. Family transitioned him to comfort measures and patient eventually passed away in the afternoon of February 21, 2022