COVID Breakthrough  Pfizer Dose 1 2/26/21 (EN6200) Pfizer Dose 2 3/30/21 (ER8727) COVID Positive 8/20/21  8/20/21: Patient is a 66 year old male with past history of end-stage renal disease on hemodialysis, history of CVA with residual left hemiparesis, and recent admission for MRSA bacteremia who was admitted through the emergency room with increased weakness and fevers as well as evidence of bilateral pneumonia.  History is obtained from chart review as well as discussion with the patient's daughters at bedside and the ED provider.  Patient is fairly lethargic although can not answer some simple questions. Recently was admitted from August 8th until August 17th. At that time he was found to have MRSA bacteremia suspected source being his hemodialysis catheter.  This was removed and then replaced prior to discharge.  Did undergo a TEE which did not show any infective endocarditis.  Was discharged with plans to continue IV vancomycin after dialysis through the 25th of August.  He is mostly wheelchair-bound after a prior stroke with left hemiparesis.  At his baseline he is able to stand and transfer and eat by himself.  He has been quite weak after discharge home and had some low-grade fevers.  Went to dialysis today and then continued to be weak and started having some cough and shortness of breath.  Was brought to the ER where his temperature was found to be 101.5.  Chest x-ray was concerning for bilateral pneumonia.  Currently he is a little better although still quite weak and not at his baseline mental status.  He does complain of a headache. Not having any nausea or vomiting.  No chest pain.  He has been vaccinated for COVID-19.  8/25/21: Patient is a 66 year old male with past history of end-stage renal disease on hemodialysis, history of CVA with residual left hemiparesis, and recent admission for MRSA bacteremia who was admitted through the emergency room with increased weakness and fevers as well as evidence of bilateral pneumonia.  History is obtained from chart review as well as discussion with the patient's daughters at bedside and the ED provider.  Patient is fairly lethargic although can not answer some simple questions. Recently was admitted from August 8th until August 17th. At that time he was found to have MRSA bacteremia suspected source being his hemodialysis catheter.  This was removed and then replaced prior to discharge.  Did undergo a TEE which did not show any infective endocarditis.  Was discharged with plans to continue IV vancomycin after dialysis through the 25th of August.  He is mostly wheelchair-bound after a prior stroke with left hemiparesis.  At his baseline he is able to stand and transfer and eat by himself.  He has been quite weak after discharge home and had some low-grade fevers.  Went to dialysis today and then continued to be weak and started having some cough and shortness of breath.  Was brought to the ER where his temperature was found to be 101.5.  Chest x-ray was concerning for bilateral pneumonia.  Currently he is a little better although still quite weak and not at his baseline mental status.  He does complain of a headache. Not having any nausea or vomiting.  No chest pain.  He has been vaccinated for COVID-19.   While on admission he was managed for COVID pneumonia and empirically covered for HAP with ceftazidime. He continued IV antibiotics for MRSA bacteremia which is to end today 8/25, his blood cultures were negative . He required oxygen during admission. He was started on steroids. Nephrology was consulted for hemodialysis.   Patient improved and was able to wean off oxygen. His dialysis days had to change because he required to set up a new chair for hemodialysis because of his COVID status.He will be undergoing dialysis today prior to discharge and will resume HD on TTS schedule upon discharge. He will be discharging on PO dexamethasone and COVID safe home program with VNA