Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Insomnia, Legionella test, Lung opacity, Nausea, Oxygen saturation decreased
Clinical narrative: PREVIOUS VAERS SUBMITTED VAERS # 777020 on  1/18/22 COVID+ 1/17/2023.  Vaccination Status J&J x1 Discharge Information: Discharge Provider: MD  Primary Care Provider : PA-C    Things requiring PCP followup:  Monitoring respiratory status post discharge.  Anxiety management Patient instructions: Take dexamethasone for 4 days, one tablet daily in the morning. This is for COVID infection.  Call and schedule appointment with your PCP in 1-2 weeks.    You can use duoneb nebulizer every 4-6 hours for shortness of breath and wheezing. You can use albuterol inhaler for shortness of breath in addition to it.  If you are noticing worsening breathing then come to hospital or call 911.  Use mucinex for chest congestion Admission Date: 1/17/2023 Discharge Date: 01/20/2023 Admitting Diagnoses: COVID-19 virus infection Discharge Diagnoses: Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 virus infection 01/17/2023 Yes ? Chronic obstructive pulmonary disease with acute exacerbation 01/17/2023 Yes ? Insomnia 01/17/2023 Yes ? GERD (gastroesophageal reflux disease) 03/22/2021 Yes ? Depression with anxiety 03/22/2021 Yes ? Chronic bronchitis 07/24/2020 Yes ? Tobacco dependence 04/20/2017 Yes ? Chronic midline low back pain with bilateral sciatica 04/20/2017 Yes ? Coronary artery disease  01/05/2016 Yes ? Essential hypertension 01/05/2016 Yes ? Mixed hyperlipidemia 01/05/2016 Yes Details of Hospital Stay PRESENTING PROBLEM:  COVID-19 virus infection [U07.1]   HOSPITAL COURSE: Per history of present illness "72-year-old with medical history of coronary artery disease, chronic obstructive pulmonary disease (on room air), hypertension, GERD, chronic back pain presenting with worsening shortness of breath, cough, increased yellowish sputum production for several days.   She presented to Hospital 1/17.  She also had nausea and few episodes of vomiting prior to presentation.  No fevers or chills.  She endorses poor appetite during this time period. In ER, patient afebrile, normotensive.  On room air at rest but with activity dropping in mid 80s.  Patient required 1-2 L supplemental oxygen through nasal cannula.  Labs remarkable for elevated proBNP 4 743, positive COVID-19.  CT angiogram chest without pulmonary embolism but showed cardiomegaly, pulmonary hypertension and bilateral ground-glass opacities consistent with COVID infection/superimposed atelectasis.  Since patient requiring supplemental oxygen, she was started on steroids and remdesivir and admitted to hospitalist service for further management." Patient tolerated dexamethasone and remdesivir.  Bacterial pneumonia workup (urine Legionella, pneumococcal antigens and procalcitonin) negative.  No sputum produced.  Dyspnea, cough improved.  Patient still continued to require 1 L supplemental oxygen through nasal cannula. 1/19 Patient completed 3 day course of IV remdesivir.  PT/OT evaluated, recommended discharge home. 1/20 infectious workup including urine Legionella and pneumococcal antigen negative, Procal normal.  No sputum produced for culture.  patient weaned off from supplemental oxygen to room air.  Home oxygen evaluation performed, patient did not require oxygen both at rest and with activity.  She herself feeling significant improvement in her breathing, cough also improved.  Patient endorsing chest congestion.  No fevers.  No abdominal pain.  Eating and drinking appropriately.  Patient was given prescription of dexamethasone for 7 days (she has higher sensitivity to steroids), Mucinex and instructed to follow-up with her PCP.  ER return precautions provided.  Patient discharged home in stable condition.