Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Asthenia, Atrial fibrillation, Brain natriuretic peptide increased, COVID-19
Clinical narrative: Adverse event information provided in this submission, is per a report received by Public Health Department from a submitting facility. Covid-19 vaccination information is from Immunization Registry. Moderna 5/20/2021 Lot number: 017C21A, Moderna 6/17/2021 Lot number 039C21A Admitted to Hospital 10/20/2022. Acute hypoxemia secondary to COVID-19/pneumonia/multiple rib fractures: New onset atrial fibrillation and Elevated troponin and Elevated brain natriuretic peptide (BNP) level. Patient had been recently admitted on 10/1-10/7/2022 after a fall. On that admission he was fluid overloaded and diuresed. When he was medically stable, he was discharged to rehab. At rehab, he developed fatigue, cough, and shortness of breath. He tested positive for COVID and was symptomatically treated as an outpatient and the facility had him in isolation. 10/20/2022 the patient had worsening shortness of breath and was sent to Hospital for further evaluation. Patient required 2 L oxygen to keep O2 sats above 90%. No oxygen requirement noted at rehab facility. Chest x-ray showed pneumonia. IV Rocephin and azithromycin ordered in ER. Per submitted note; He did not meet sepsis protocol. X-ray of patient?s ribs showed multiple rib fractures. Lidoderm patch, Tylenol, and tramadol provided for pain control. PT/OT ordered. COVID-19 inflammatory markers elevated, will monitor intermittently. Steroids and vitamins ordered. EKG showed new onset A. fib with rate control of 55. Patient was anticoagulated on warfarin, PT/INR was supratherapeutic, rechecked and Pharmacy to dose. Troponin elevated. Patient denies any chest pain. EKG shows new onset A. fib, but no acute ischemic changes, lab work-up was unremarkable. Patient denied any chest pain, nausea, vomiting, lightheadedness, dizziness, fever, chills, dysuria, constipation, diarrhea, or abdominal pain.   2nd report received: (unknown length of stay of prior 10/20/2022 admission) Patient was recently admitted on 10/20/2022 for hypoxia secondary to pneumonia, COVI D-19, and rib fractures. Patient was found to be in new onset A. fib. Cardiology adjusted medication and patient was discharged on Augmentin for pneumonia. Patient was discharged in stable condition and was sent back to his facility. Family noticed over the last week that at times he was more confused and weaker. They noticed a cough again over the last few days as well. 11/5/2022, patient was so weak that he was unable to get out of bed and family had him sent back to the ER for further evaluation. Chest x-ray showed worsening pneumonia. He is not requiring any oxygen at this time. CT of head was negative. BNP improved from baseline. Patient appeared dry, despite leg edema. Gentle IV hydration was ordered. Compression stockings were ordered. The rest of his lab work-up was unremarkable. Patient denies any chest pain, shortness of breath, nausea, vomiting, lightheadedness, dizziness, fever, dysuria, diarrhea, or abdominal pain. Unfortunately, after hospitalization and treatment in the hospital patient continued to decline. On 11/8/2022 patient took started experiencing worsening of his mentation, prolonged pauses of his heartbeat. The trajectory of patient disease was discussed with the family, Patient?s family agreed on further management of comfort measures. Patient was transferred to hospice. On 11/8/2022 patient was pronounced dead at 1420. County Public Health has no further information. Please contact providers for additional information.