Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Agitation, Anxiety, Constipation, Death, Decreased activity
Clinical narrative: This patient was medically fragile and on hospice care at the time of the event. We are reporting this because the EUA at the time stated to report all deaths. However, it is unlikely this was related to the vaccine. The patient received her first Pfizer vaccine on 6/3/2021 and expired on 6/15/2021. Per Death Summary: Cause of Death: ischemic cardiomyopathy Patient was admitted to Hospice on 6/14/2021 for the diagnosis of Ischemic cardiomyopathy. Her symptoms of pain, dyspnea, delirium, respiratory secretions and aspiration were managed with both medications and behavioral interventions. The Hospice interdisciplinary team was involved in care of patient and family. She died peacefully at 1425 on 6/15/2021 with her family at the bedside. The hospice bereavement team will follow up with the family. History and Physical note: #1 new hemoptysis: The etiology of this is unclear. There is not a simple answer such as secondary to epistaxis or dental problems. The patient is not fully anticoagulated and takes only 81 mg of aspirin a day. She is about 1 week status post first Covid vaccination. We will check a CBC and platelet count. This could represent pneumonia in the right lung with secondary hemoptysis or it could represent primary hemoptysis in the airways leading to aspiration of blood within the lung. Her oxygen saturation and respiration rate are okay with 2 L of supplemental oxygen. However, it is very early in the course and she could progress with further respiratory distress. #2 delirium and dementia: The family clearly describes several days of distinct delirium with hallucinations and mixed hyper and hypoactivity. Her baseline dementia is primarily forget fullness and lack of self-care. #3 ischemic cardiomyopathy: The patient does not have symptoms that are unstable regarding this baseline disease. She does not have signs of decompensated heart failure or volume overload. Prior to Admission Medications LORazepam (ATIVAN) 0.5 mg tablet  Sig: Take 0.5 mg by mouth every 6 hours as needed for anxiety. indications: anxious acetaminophen (TYLENOL) 325 mg Tablet  Sig: Take 650 mg by mouth every 6 hours as needed for Fever or Pain. Acetaminophen (TYLENOL) 650 mg Suppository  Sig: place 650 mg rectally every 6 hours as needed (mild pain or fever). Indications: mild pain or fever aspirin (ECOTRIN) 81 mg EC tablet  Sig: Take 81 mg by mouth nightly. bisacodyL (BISCOLAX) 10 mg suppository  Sig: Place 10 mg rectally as needed (constipation). Indications: constipation donepezil (ARICEPT) 5 mg tablet  Sig: Take 5 mg by mouth nightly. famotidine (PEPCID) 20 mg tablet  Sig: Take 20 mg by mouth 2 times daily. furosemide (LASIX) 40 mg tablet  Sig: Take 40 mg by mouth daily as needed (edema). haloperidol (HALDOL) 2mg/mL solution  Sig: Take 1 mg by mouth every 6 hours as needed (agitation). Indications: agitation hyoscyamine (ANASPAZ,LEVSIN) 0.125 mg tablet  Sig: Take 0.125 mg by mouth every 4 hours as needed (terminal secretions). Indications: terminal secretions ibuprofen (ADVIL LIQUI-GEL ORAL) Sig: Take 200 mg by mouth 3 times daily. magnesium hydroxide (MILK OF MAGNESIA) 400 mg/5 mL suspension  Sig: Take 30 mLs by mouth 2 times daily as needed for Constipations. magnesium hydroxide (MILK OF MAGNESIA) 400 mg/5 mL suspension  Sig: Take 10 mLs by mouth daily. memantine (NAMENDA) 10 mg tablet  Sig: Take 10 mg by mouth at bedtime: mirtazapine (REMERON) 7.5 mg tablet  Sig: Take 7.5 mg by mouth nightly. morphine (ROXANOL) 20 mg/1 mL concentrated solution  Sig: Take 5-10 mg by mouth every 3 hours as needed (secere pain or dyspnea). Indications: secere pain or dyspnea