Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Incoherent, International normalised ratio increased, Lung infiltration, Lung opacity, Metabolic encephalopathy
Clinical narrative: COVID Vaccine Breakthrough Case  Pfizer Dose 1 3/18/21 (EN6208) Pfizer Dose 2 4/14/21 (EW0153) COVID Positive 11/24/21  11/24/21: History obtained from medical records, wife is not present at bedside.  History limited due to confusion.   An 83-year-old man with a history of atrial fibrillation, on anticoagulation therapy with warfarin, type 2 diabetes mellitus, dyslipidemia, sleep apnea, who was brought in by the EMS with complaints of confusion.  Patient lives with his wife, who noticed that he was incoherent and not acting like himself after dinner.  No loss of consciousness.  No history of falls.  On presentation to the emergency room, patient was noted to be febrile with temperature of 102 degrees, blood pressure was elevated to 188/95mmHg.  Laboratory workup CMP within normal limits.  CBC reveals normocytic anemia with hemoglobin of 12.1, INR is 2.5.  COVID-19 screen presented negative.  Urinalysis reveals WBC of 4 to 10 per high-power field.  Chest x-ray done, infiltrating the left upper pole of.  Patient received IV ceftriaxone and azithromycin is being admitted to the hospitalist service.  11/28/21: Patient was admitted and found to be COVID-19 positive.  Continued to have intermittent low-grade fevers however he developed no shortness of breath or cough.  Was noted to have urinary retention and Foley catheter was placed.  Blood cultures on admission were positive for Gram-positive cocci in clusters and he was started on vancomycin.  Repeat blood cultures were drawn and remained negative.  He grew 2 different species of coag-negative staph which were consistent with contamination.  Vancomycin was discontinued.  Patient will discharge home with COVID-19 at home.  He should follow-up with Urology in 1-2 weeks for voiding trial.  11/29/21: This is an 83-year-old male with history of hypertension, type 2 diabetes mellitus, atrial fibrillation on chronic anticoagulation with Coumadin who presented to the emergency department with generalized weakness and fatigue. Patient was admitted on 11/24/2021 and was discharged yesterday on 11/28/2021 for acute metabolic encephalopathy, COVID-19 infection and a Gram-positive bacteremia. He reports that he has been feeling very weak and tired and unable to stand up steadily since leaving the hospital.  Visiting nurses' services were ordered but due to some delays patient has not been seen by visiting services. He has no chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea or constipation.   In the emergency department, labs showed a WBC count of 3.2, hemoglobin of 12.3 and platelets of 128, INR of 2.1. Chest x-ray showed increased right perihilar opacification concerning for pneumonia. Patient was given IV fluids and a dose of IV Levaquin.  12/3/21: P.o. Levaquin course P.o. Januvia 100 mg daily  P.o. glyburide 5 mg b.i.d.  Resume home metformin  Monitor Accu-Cheks  Will hold today's Coumadin dose  Repeat INR tomorrow and resume on p.o. 5 mg daily if INR is less than 3 tomorrow.  Hemodynamically stable for discharge  Will discharge to skilled nursing facility  Follow-up with PCP in 3-5 days