Age: 90.0
Sex: F
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Asymptomatic COVID-19, Bacterial test positive, Blood culture, Blood lactic acid normal
Clinical narrative: COVID Vaccine Breakthrough Case  Pfizer Dose 1 12/28/21 (lot NA) Pfizer Dose 2 1/18/21 (lot NA) COVID Positive 12/1/21  12/1/21: Patient is a 91 year old female with PMH osteoporosis and vascular dementia who presented to the ED today for confusion and possible UTI.   She was seen earlier today in clinic at which point her daughter noted the patient was having cloudy, dark urine with confusion.  She has history of UTI in the past that had similar symptoms and required hospitalization.  She also noted cough with others in her home being ill about 1 week ago.  She was advised to go to the ED for futher evaluation.   Upon exam her daughter noted that cold symptoms started on Saturday including a productive cough and rhinorrhea.  On sunday she began to develop confusion and decreased appetite.  Since that time she notes patient has gradually declined.  She has had some diarrhea.  She has had some incontinence which is not typical for her. Denies use of any OTC medications.  Not on any medications at home.   In the ED: Patient arrived tachycardic at 95 bpm with otherwise stable vitals and afebrile.  Labs were notable for Na 125, K 3.0, normal WBC and lactic acid, negative troponin.  Urine studies notable for moderate leuk esterase, trace blood, and few bacteria.  Urine and blood cultures obtained and pending.  CXR indicated no acute cardiopulmonary processes.  Head CT negative for acute findings.  EKG showed normal sinus rhythm.  Patient was given 1g Ceftriaxone, KCl 20 mEq, NS 500 ml.   Surgical Hx: cholecystectomy  SH: former smoker, lives with daughter  FH: noncontributory  12/6/21: Patient is a 91 year old female with PMH osteoporosis and vascular dementia who initially presented to the ED for confusion for 4 days in the setting of cold symptoms and other sick contacts within the home.  She was saturating well on room air and was afebrile, however did test positive for COVID.  She also noted dark and cloudy urine similar to previous UTI's. Urine was notable for a UTI for which she was treated with a 3 day course of IV ceftriaxone.   Confusion was thought to be due to hyponatremia which was slowly corrected with free water restriction and NS boluses.  CT head indicated no acute findings.   Throughout her admission her sodium normalized and she remained asymptomatic with COVID.  She did not qualify for any treatments for COVID per protocol aside from anticoagulation for which she was treated with subcutaneous heparin.  She never required supplemental oxygen.  Her family was initially requesting SNF placement due to deconditioning however upon finding out that the patient would need to remain in the hospital until 10 days from the first positive test due to regulations at the nursing home they chose to have her discharge home to their care instead with COVID safe at home and VNA.  On day of discharge patient was unhappy, believing she would have to stay, however was not requiring any supplemental oxygen and remained asymptomatic.   IMPROVE VTE score at discharge was 1 so patient did not require any outpatient anticoagulation.