Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Blood fibrinogen increased, Blood gases abnormal, Blood lactate dehydrogenase increased, Blood lactic acid, Blood pH decreased
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/11, Pfizer, dose #1 02/03, Pfizer, dose #2 08/31 pt cc: cough, fatigue, headache, rhinorrhea, congestion, exposure: unknown 09/01 COVID-19 ANTIGEN BINAX results: detected 09/01 CXR impression: No acute cardiopulmonary abnormality. Remainder of findings as above. 09/11 CXR impression: Lungs: There are interstitial and airspace opacities within the peripheral left mid and lower lung and more subtle opacities at the right medial lung base. Findings are suspicious for an infectious/inflammatory process, including atypical such as COVID-19 pneumonia. Pleura: No visible pleural effusion. No pneumothorax. Mediastinum: Heart size is within normal limits. There are aortic calcifications. There is a left chest dual-lead cardiac pacemaker. There is a right chest port with the tip over the SVC. 09/11 CTA impression: 1. No evidence of pulmonary embolism. Note that small segmental and subsegmental pulmonary emboli cannot be excluded due to breathing motion artifact. 2. Bilateral groundglass opacities and alveolar opacities, with a peripheral predominance compatible with multifocal pneumonia. Pattern consistent with reported COVID-19 3. A 8 mm subpleural nodule in the superior segment of the left lower lobe, similar in appearance to prior exams. July 30, 2021 PET/CT reports similar to exams dating back to at least March 2019. Suggest close attention on follow-up imaging given history of malignancy. 09/11 COVID swab, result: detected 09/11 FERRITIN >37840 09/11 SARS-COV-2 TOTAL AB, SPIKE <0.4 09/11 BNP 59.9 09/11 pt admit to medicine cc: dyspnea dx: acute hypoxemic respiratory failure d/t COVID PNA LOS: 18 DAYS 09/11 lactic acid 1.15 09/12 FIBRINOGEN 804 09/12 DDIMER 1.01 09/12 SARS-COV-2 Variant Sequencing result: pending 09/12 SARS-COV-2 IGG Eval: 0.01 09/12 i-pH 7.43, i-PCO2 31.5, i-P02 63, i-HCO3 21.0 09/12 ESR 40 09/13 FIBRINOGEN 491 09/13 DDIMER 0.66 09/13 ESR 13 09/16 i-pH 7.47, i-PCO2 33.4, i-P02 67, i-HCO3 24.6 09//16 CXR impression: Increased opacities in the left lung compared to the prior exam. Similar right lower lung opacities. 09/17 DDIMER: 0.38 09/18 i-pH 7.50, i-PCO2 32.1, i-P02 44, i-HCO3 24.7 09/20 i-pH 7.46, i-PCO2 34.0, i-P02 79, i-HCO3 24.2 09/21 FIBRINOGEN: 449 09/21 DDIMER: 0.43 09/21 ESR: 30 09/22 CXR impression: Similar bilateral, left greater than right heterogeneous pulmonary opacities. Consistent with COVID pneumonia. 09/23 FIBRINOGEN: 391 09/23 DDIMER: 0.41 09/23 ESR: 30 09/26 CXR impression: Since 9/22/2021: No substantial interval change in bilateral airspace opacities, left greater than right, consistent with multifocal Covid pneumonia. 09/27 FIBRINOGEN: 638 09/27 DDIMER: 0.55 09/27 ESR: 50 09/27 VIRAL RESPIRATORY CULTURE/QUEST results: pending 09/27 MYCOLOGY CULTURE BRONCHUS (quest) results: pending 09/27 ABG: i-pH 7.34, i-PCO2 52, i-P02 60, i-HCO3 28.2 09/27 FUNGUS SMEAR SPUTUM (QUEST) results: pending 09/27 PNEUMOCYSTIS JIROVECII DNA (QUEST) results: pending 09/27 MRSA PCR results: not detected 09/28 ABG: I-pH 7.40, i-PCO2 37.0, i-P02 49, i-HCO3 22.7 09/28 hit-ab: negative 09/28 CXR impression: No significant interval change. 09/29 po4 4.5 09/29 LDH 414.6 09/29 FERRITIN 9572.7 09/29 FIBRINOGEN: 749 09/29 ESR 62 09/29 CRP 18.993 09/29 CXR impression: No significant interval change. 09/29 pt decease