Preceding adverse event: The adverse event occurred on 8/30/2021. Patient had seen his kidney specialist, nurse practitioner, on 7/29/2021 and his primary care physician Dr. on 8/11/21. His ICD/pacemaker was interrogated on 08/04/21. He had multiple lab tests on 07/22/2021. All results from all of these assessments were at baseline or better.   History of response to infection or other conditions causing ramp up of immune system: Patient had a mild and transitory reaction to his second covid vaccination that included the following symptoms. Additionally, every time he had any type of infection or other illness this trifecta of systems was observed. He consistently (1) became very weak quickly and would be unable to even stand; (2) he would have jerky myoclonic type movements of his arms and sometimes legs; (3) normally he had no dementia or other cognitive disorder but during these times his thinking would become sluggish, he would have difficulty processing information, and would sometimes become confused. During the times these situations resulted in him being admitted to the hospital, it was also noted that his creatinine would rise sharply until the presenting illness or infection resolved at which time it would drop back to baseline.   Adverse event: Patient went to a routine medical appointment to get a prescription for a new part for his prosthesis on 08/30/2021. He felt well and had normal vitals. At that time, he inquired whether it was possible to get third vaccination booster because of his pre-existing conditions. It was agreed that that was reasonable, and he received the vaccination at approximately 12:00 PM.   Events following the adverse event until arrival at the emergency department on 09/04/2021  08/31/2021: Patient woke up noting he had had terrible dreams and did not feel well. He then recalled that he had had the vaccination the previous day and his responses were likely the expected reaction to the vaccination. As the day progressed, he began exhibiting the previously described trifecta of symptoms. By that night he was not able to walk in order to go to bed and slept in his lounge chair. While these symptoms were concerning, we assumed they would be transitory as they had been with the second vaccination since he did not have any other illness currently.   09/01/2012: Patient woke up feeling better although still having mild symptoms as previously described. He was able to walk upstairs, eat breakfast at the table, and generally felt much better, although still weak. By late afternoon he began having an increase in symptoms but thought at that time it was likely just because he was fatigued from the activities of the day.   09/02/2021: Patient was not able to stand up throughout the day, but symptoms slightly waxed and waned and it was difficult to be certain whether he might be getting better or not. It was observed that his urine output was low and he appeared to be retaining some fluid in his midsection. It was not possible for him to weigh because he could not stand. His primary care physician was contacted for any recommendations. The recommendation was to contact the kidney provider. His kidney provider was contacted to determine if it was safe for him to take a Bumetanide and she said he could do that. Following that there was a slight increase in urine output. His temperature was 98 and his oxygen saturation was 97%.   09/03/2021: Patient had heard a number of people say that they had significant symptoms for four days following the vaccination, so it was decided to monitor at home for one more day to see if things would markedly improve. Typically, he would have gone to the emergency department on this day but decided to give it one more day because with the covid protocols in place at the hospital he would have had to go alone and that was very anxiety producing. His urine output remained low but slightly more than on 09/02/2021. Again, there was some waxing and waning of symptoms throughout the day but no clear course of either improvement or deterioration.   09-04-2021: He was clearly not better and if anything he was worse and the decision was made to have him taken to the emergency department by ambulance.