Age: 94.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood creatinine abnormal, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Cardiac failure congestive
Clinical narrative: Patient with 2 Pfizer vaccinations who admitted with positive COVID test and was found to be positive for COVID during admission testing.  Patient admitted for four days and discharged home with provider discharge note below:   "95 year old man with a history of pulmonary fibrosis and COPD, not chronically on oxygen who is vaccinated for Covid-19 presented with generalized weakness. He was found to be Covid-19 positive, deferred Regeneron, but was thankfully relatively asymptomatic presenting with no respiratory symptoms. He was also found to have bilateral upper and lower lobe infiltrates on CXR and empirically treated for CAP. He was assessed by therapy and deemed appropriate to return home with therapy and assist at the time of discharge. After observing patient in a hospital setting, he was able to improve in strength with a notable improvement in appetite as well. Patient was discharged to home with remaining doses of antibiotics for CAP coverage.  Of note, patient was found to have ESR and CRP elevation. Though it is likely that these inflammatory markers are elevated due to Covid-19, repeat labs were ordered in the outpatient setting and if they continue to be elevated, patient will need additional work up/follow up with PCP and Rheumatology to assess for possible PMR. "  Of note - patient readmitted 12/30/21 was admitted to hospice services and ultimately died on 01/09/2022.  12/30/21 provider discharge note below:  "Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  These were his acute medical issues addressed at home.   Pneumonia due to COVID-19 12/11/21 - was not hypoxic at rest initially, but dropped severely with ambulation and needs O2, recovers very slowly.  - received rocephin and doxy initially with elevated procal (has ckd) D7. - was treated for CAP as well  Last 12/11/21 hospitalization. - MRSA nares was negative. - Cefepime restarted.   SOB -- persistent, despite treatment.          -- multifactorial cause: Post COVID, CHF, ?HCAP, prob ILD, ?Autoimmune lung dse; certainly has an anxiety component.          -- fluid positive.          -- Given Lasix BID. O2 via nasal canula          -- appreciate Dr. input. We are treating everything: Lasix/ Cefepime/ Steroids.          -- will add low dose Ativan or Xanax.          -- long term steroids planned (3-4 weeks) per Dr.          -- will d/w CARDS whether a component of PM dysynchrony can be contributing?   AKI -- overdiuresed. DC diuretics. Check daily BMP.        -- SCr rising   RF positive serology -- ?has RA lung. This may be non specific per Dr.                                      -- anti --CCP ordered   Diarrhea- Has made him more fatigued/weak. start probiotic and Imodium.                 - C diff was negative.   CKD- at baseline CAD HLD HTN Anemia   Today 1/9/22: Has not improved in the last several days despite ongoing treatment above. Now drowsy and more somnolent. D/W family his non improving state. They are interested in a Hospice info visit. This is most appropriate and I support this.   Hospice RN visit made. Family signed Hospice papers discussion with Hospice RN. Patient  is discharged to IP Hospice for end of life care and will remain GIP at Hospital."