Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Atrioventricular block second degree, Bilevel positive airway pressure, Bradycardia, C-reactive protein, COVID-19
Clinical narrative: Pfizer COVID Vaccine EUA  Patient received 1st dose of Pfizer vaccine 3/11/21.  3/27/21: Patient is a pleasant 63-year-old female past medical history of anxiety, documented history of hyperlipidemia  came in from outside facility with complaints of dyspnea, COVID-19 pneumonia, bradycardia. Clinical picture started on the 17th patient tested positive for COVID-19 at that time was having symptoms myalgia, subjective dyspnea reportedly went to the emergency department, saturations were good she was discharged home with conservative measures.  At home became more symptomatic and pulse ox was measuring in the low 80s so she went back to the hospital and was admitted to Hospital on 03/25.  Per records patient was started on Eliquis, dexamethasone, azithromycin, remdesivir, p.r.n. Tylenol, p.r.n. Zofran, p.r.n. Toradol along with supplemental oxygen.  Oxygen requirement was 5 L at the facility.  However overnight and prior to arrival providers at outside facility started noticing bradycardia patient's heart rates were dropping into the 30s.  Patient was asymptomatic during these episodes not complaining of any lightheadedness or chest pain.  Reportedly cardiologist saw patient QT and QTC were reportedly appropriate recommended monitoring.  However overnight heart rate continued to go down into the 30s, reportedly on telemetry was noted to be developing Mobitz 2 second-degree block, patient was administered atropine x2 and heart rates improved to the 70s however a year started going down again to 30s and 40s after a couple of hours.  Outside facility requested transfer to another hospital for further management and possible EP intervention.  Bedside patient is lying comfortably in bed currently denies any lightheadedness, dizziness, chills, fevers, nausea, vomiting, diarrhea, chest pain, palpitations, paresthesia, swelling of extremities.  Though is she gets winded after exertion, is okay/comfortable on supplemental oxygen at rest.  Patient was increased to 8 L during ambulance ride, was id saturating however medics increased because of bradycardia. Otherwise denies tobacco, recreational drug/marijuana, over-the-counter/herbal medication use.  Social consumption of alcohol will have 1-2 beers a year.  She reports sick contact 1 of her close friends was diagnosed with COVID earlier this month, husband also positive.  She reports she received 1st dose of COVID-19 vaccination around the 10th or 11th of this month 1 day prior to known exposure. Otherwise no medication changes is only on sertraline. Currently no antihypertensive medication or rate-controlling agents.  4/1: Patient was admitted after developing significant bradycardia after receiving remdesivir for COVID-19 pneumonia.  Remdesivir was held and patient received convalescent plasma on 03/28.  Dexamethasone was started at the outside hospital on 03/25.  With also completed 5 days of empiric doxycycline and Rocephin.  Patient CRP and D-dimer were followed and trended down at the time of discharge.  EP Cardiology was consulted and initially the patient was on dopamine for the 1st 2 hospital days.  Was able to be stopped and the last 2 hospital days the patient had no bradycardia.  She will have a Holter monitor as an outpatient.  Patient wore her BiPAP at night.  Oxygen requirements trended down and was able to be on room air at the time of discharge.  Home O2 evaluation was performed and did not require oxygen.  She will continue on 5 further days of Decadron 6 mg daily.  She will follow-up with her PCP.