Age: 74.0
Sex: M
Vaccine: COVID19-2, FLU4, COVID19-2, FLU4
Symptoms: Device related infection, Diuretic therapy, Dysphagia, Echocardiogram, Enterococcal infection
Clinical narrative: PREVIOUS VAERS SUBMITTED.  VAERS 904484 submitted 10/24/22 COVID + 11/27/22 (previous documented COVID+ status in October 2022)  Vaccination status - Pfizer x3 + Pfizer bivalent   BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider at Discharge: PA-C  Admission Date: 11/27/2022 Discharge Date: 12/2/2022   Active Hospital Problems   Diagnosis Date Noted POA ? Acute metabolic encephalopathy 11/04/2022 Yes ? Acute cystitis with hematuria 11/28/2022 Yes ? COVID-19 11/27/2022 Yes ? Iron deficiency anemia due to chronic blood loss 11/01/2022 Yes ? Persistent hematuria 11/10/2022 Yes ? Chronic diastolic congestive heart failure 10/31/2017 Yes ? Hyperkalemia 11/27/2022 Yes ? Enterococcus faecalis bacteremia 10/05/2022 Yes ? Enlarged prostate 10/10/2022 Yes ? Infection of prosthetic left knee joint 11/28/2022 Yes ? Hypothyroid   Yes ? Dysphagia 12/02/2022 Unknown ? Urinary retention 11/12/2022 Yes ? Morbid obesity 09/07/2018 Yes ? Stage 3a chronic kidney disease 08/24/2018 Yes ? OSA (obstructive sleep apnea)-severe   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 HOSPITAL COURSE:  74 year old male known to hospital for several recent admissions.  He was admitted in October with COVID and was thought to be community-acquired pneumonia.  At that time his blood cultures were positive for Enterococcus faecalis with an unclear etiology.  Per Infectious Disease recommendations he is transferred downtown for a TEE which was essentially negative for vegetations.  He had a PICC line placed and was continued on penicillin until November 22nd.  He was then transition oral Augmentin.  He underwent removal of hardware by Dr. from the left knee on October 31st.  This was complicated by persistent hematuria and acute renal failure.  He also was fluid overloaded at that point in time.  He has been anemic several times and required blood transfusions. 2 units of packed red blood cells on 10/06 2 units of packed red blood cells on 11/02 2 units of packed red blood cells on 11/05 2 units of packed red blood cells on 11/28    He was admitted with hematuria, ARF, anemia, and hypotension.   This morning, patient is hard of hearing, but able to answer question appropriately.  He is oriented x3.  Slight cough overnight.  No fevers or chills.  No chest pain or shortness of breath.  Told me that they were planning on left knee replacement, but ended up coming here due to unstable vitals.   Gross hematuria.  Hx of BPH. Status post traumatic Foley insertion in the middle of November, requiring transfer.  This was treated conservatively with CBI, patient was followed outpatient by urologist on 11/21, Foley catheter was discontinued, was recommended to follow up for PVR this week.  Patient was started on Avodart. 11/29/2022 Admitted this am again for hematuria and ARF. Last visit he was transferred for Urology evaluation, but only had continued CBI. Never had cystoscopy.Three way catheter occluded and he needed it changes. CXR reveals continued fluid overload. Will start diuresis despite elevated creatinine. 11/30/2022 Called Urology and told the patient should follow up with Dr. He seems to be diuresing. Urine is slowly clearing up. His mental status is better. 12/01/2022 Anemia worse again today. Transfuse 2 units pRBCs today. Increase diuresis to furosemide 40 mg IV BID. Contacted Dr. She believes the patient should be transferred for Urology evaluation and cystoscopy.  12/02/2022 facility has accepted the patient. He will be transferred to see Dr for cystoscopy and definitive treatment of recurrent hematuria. CBI was finally stopped today, bc urine started clearing. He is breathing well. He is diuresing and he is appropriate. Hemoglobin is stable.  PATIENT TRANSFERRED TO facility  CURRENT INPT THERE.