Pfizer Dose 1 8/19/21 (FC3182) Pfizer Dose 2 9/9/21 (FF2588) COVID Positive 1/31/22  1/31/22: Patient is a 69 year old male who presented to ED with complaints of chest pain. Chest pain started yesterday and has progressively worsened. Chest pain is centralized, non-radiating, squeezing in nature, 5/10, eating or aggravating factors.  He has associated shortness of breath,  on exertion.especially on exertion. Intermittent lightheadedness and generalized weakness. He also endorses reflux like symptoms for the past several days, stated he has taken several tums over the past week. Since Friday he has been having several black tarry stools per day. Denies abdominal pain, nausea or vomiting. No hematemesis. Patient did have recent stent placement last month at another facility, he is taking Plavix and a baby aspirin daily. He denies any other NSAID use. He does drink but reports only on the weekends. No previous GI history. He has a past medical history significant for hypertension, hyperlipidemia, type 2 diabetes mellitus, coronary artery disease s/p PCI.   On arrival to ED patient was hypertensive 160/80 and tachycardic at 100. Laboratory findings were significant for hyperglycemia 218. CKD 301. FOBT positive.  Severe anemia HGB 4.8.  Chest x-ray unremarkable.  EKG sinus tachycardia, posterior infarct age undetermined, rate 111, QTC 492. Patient received 4 baby aspirin in ED, Protonix 80 mg IV and IV fluid resuscitation with NS 0.9% 1 L bolus. Protonix GTT initiated in ED.  2/5/22: Patient is 69-year-old male with past medical history of CAD Sp PCI with deployment of DES on 12/27/2021, hypertension, dyslipidemia and type 2 diabetes mellitus. He presented to the emergency room with a complaint of chest pain and exertional dyspnea.  He also reported lightheadedness and dizziness.  He reported generalized weakness.  He reported epigastric abdominal pain with reflux.  He reported several episodes of tarry stool.  He denied nausea vomiting.  Upon evaluation at the emergency room, he was hemodynamically stable but tachycardia with heart rate 100. FOBT was positive.  CBC revealed with hemoglobin of 4.8 gram/deciliter.  Patient was admitted for further evaluation and treatment of acute severe symptomatic blood loss anemia likely due to GI bleed.  He was started with IV Protonix drip.  He was transfused with multiple units of PRBC to keep his hemoglobin above 8 in view of recent PCI.  In view of recent cardiac catheterization with PCI with high risk of InStent thrombosis, his dual anti-platelet therapy was continued aspirin and Plavix.  GI team was consulted.  Patient underwent EGD and was noted to have severe gastroesophageal reflux disease with ulcers.  No biopsy was obtained as patient is on dual anti-platelet therapy aspirin Plavix. Patient underwent EGD which did not show any active bleeding.  GI team plan to do capsule endoscopy as an inpatient which was declined as patient has COVID-19 infection.  However, patient was asymptomatic with no hypoxia or respiratory symptoms.  Was placed on contact and droplet precautions.  His respiratory status remained stable.  Patient required 6 units of PRBC transfusion to maintain his hemoglobin.  He has dual anti-platelet therapy was briefly held.  However, it was resumed to avoid risk of InStent thrombosis.  Plavix was loaded with 600 mg stat followed by 75 mg p.o. daily.  Patient was extensively counseled to continue taking dual antiplatelet therapy aspirin and Plavix until told by his PMD or cardiologist. Patient is being discharged home with oral Protonix 40 mg b.i.d..  He was instructed to avoid NSAIDs use.  Post transfusion, his hemoglobin remained stable.  On day of discharge, his hemoglobin was at 8.1 gram/deciliter. Patient will have repeat CBC in 3-5 days and result to be followed by PMD.  Will follow-up with PMD in 3-5 days. Follow-up with cardiologist in 1 week.