Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Biopsy stomach, Blood glucose increased, Blood sodium decreased, Blood urea nitrogen/creatinine ratio increased, COVID-19
Clinical narrative: Moderna Dose 1 3/25/21 (017B21A) Moderna Dose ? 3/30/21 (probably mistakenly recorded by human error) Moderna Dose 2 4/23/21 (006C21A) Presented to ED and transferred 9/30/21 COVID Positive 10/1/21  10/1/21:A 76-year-old male past medical history significant for diverticulosis status post bowel resection, essential hypertension, GERD, type 2 diabetes mellitus,  presented to Emergency Room after s/p fall and bloody bowl movement of 1 day.  Patient endorses that she was going to the bathroom when walker "went ahead "of her and fell to the ground.  She was unable to get up and laid on the ground for 2 hours until EMS arrival .  While laying on the ground  patient had the urge to defecate and  had bowel movement.  Per EMS and patient there was dark tarry stool mixed with blood.  Patient denied any abdominal pain nausea or vomiting. Patient denied any previous melena or hematemesis   Patient was diagnosed with COVID-19 infection on 09/29/2021 and got plasma infusion to days back.  Patient was also vaccinated with modern a COVID-19 vaccine in July 9 to August  .   Patient had colonoscopy in 2018 and per patient had removal of polyps.  Patient also had bowel resection surgery in 2011 for diverticulosis  In the emergency room  lab was significant for low sodium of 129, elevated blood glucose of 297 with BUN/creatinine ratio of 36. Hemoglobin was 11.9.  COVID-19 done on 09/27/2021 was positive.  CT abdomen and pelvis with IV contrast showed duodenitis, possibly related to peptic ulcer disease.  No perforation; cholelithiasis without evidence of acute cholecystitis.  Patient was started with Protonix drip by the referring physician   10/3/21: 76-year-old female with a history of HTN, T2 dm, GERD and the bowel resection for diverticulosis admitted for episode of probable syncope and melena stools.  She has a chronic headache for which she takes NSAIDs regularly. At the emergency room the vital signs were normal.  The hemoglobin was 11.9 grams/dL.  Routine COVID 19 screen came back positive but patient has no respiratory symptoms and she is fully vaccinated against COVID 19. She was diagnosed with likely upper GI bleed was admitted to hospital.  Later that night she had upper GI endoscopy and it revealed a medium-sized hiatal hernia, diffuse gastritis, clean based pre-pyloric ulcer, multiple large distal duodenal bulb ulcer.  Patient required placement of a hemoclip for a visible ulcer in the duodenal bulb with successful hemostasis.  Back to the medical ward she has been doing fine and hemoglobin fairly stable.  She has been on pantoprazole infusion since admission.  On re-evaluation this morning she feels fine was able to eat solid meal without any complaint.  The repeat hemoglobin this morning is 9.5 grams/dL which is stable.  She will be discharged home and will continue with oral pantoprazole 40 mg b.i.d. until re-evaluated by the gastroenterologist. Gastric/Duodenal biopsy for Helicobacter pylori is pending and hopefully will be available when she follows up with the GI specialist.