COVID Breakthrough Case  Pfizer Dose 1 2/4/21 (lot NA) Pfizer Dose 2 3/4/21 (lot NA) Pfizer Dose 3 8/19/21 (lot NA) COVID Positive 11/30/21 COVID Positive 12/18/21  12/18/21: Patient is a 71-year-old male with past medical history of Diffuse large B-cell lymphoma, arthrosclerosis , chronic AFib, descending thoracic aorta dissection in 2019, retention, hypothyroidism, former smoker, morbidly obese, OSA, COVID-19 recovered who presented to the ED with some hypoxia.  Patient reports he was diagnosed with COVID-19 and November 30 . on 12/13/21, patient developed pneumonia and was started on Levaquin. Patient continued to feel unwell.  Today he reports his saturation was 85 on room air so he came to the ED.  the patient has received whole COVID-19 vaccination including posterior.  Patient received a monoclonal antibody a week ago.  Currently patient denies fevers/chills, chest pain, headache, nausea, vomiting, abdomen pain, cough, dizziness.   In the ED temperature 102.9°,  86% on room air, RR 22, blood pressure 104/64.  Patient initially was placed on BiPAP A1c improved has been on 6 L nasal cannula.  CT chest negative for PE, showed diffuse bilateral consolidation consistent with pneumonia and stable type B descending thoracic aortic dissection with increasing aortic diameter. Sodium 128, potassium 3.0, creatinine 1.42, ALT 129, AST 201, ALP 64, T bili 0.7, lactic acid 3.2, proBNP 1100,: 0.05, VBG pH 7.54, pCO2 28, bicarb 24. WBC 9, hemoglobin 12.8, INR 3.3, D-dimer 2.11, COVID-19 rapid antigen negative and flu negative.  Patient received Decadron and Zosyn in the ED.  ED provider did speak with CT surgeon-Dr. who reviewed CT chest imaging. Recommendation is dissection is stable and patient is not a good surgical candidate so for patient to follow-up with his CT surgeon.  12/20/22: Patient is a 71-year-old male.  He was diagnosed with COVID-19 on 11/30/2021.  He received monoclonal antibodies as an outpatient following his diagnosis.  He was fully vaccinated with booster  via Pfizer vaccine prior to his diagnosis.  He continued to do poorly as an outpatient.  He therefore presented on 12/18/2021 with chief complaint of shortness of breath.  He was struggling to maintain adequate saturations at home.  He was therefore admitted to the hospital on 12/19/2021.  He continued to do poorly in the hospital and was intubated on 01/04/2022. Throughout his hospital course, the patient experienced several complications.  His kidney function worsened and he was placed on dialysis.  He was also diagnosed with bilateral lower extremity DVTs.  He also had GI bleeding. His bleeding was thought to be hemorrhoidal.  It stopped and his hemoglobin remained stable.  He was therefore placed on anticoagulation.  Patient underwent tracheostomy and PEG tube placement on 01/13/2022.  Sedation was discontinued however patient remained poorly responsive, neurology was consulted some improvement in mentation MRI results as noted.  For recommendation will treat patient for sinusitis.  Will need nutritional/metabolic labs at select TSH levels, B12/folate.  Will need to continue trending hemoglobin levels.  Okayed for discharge from neuro and pulmonary critical care standpoint.  therefore discharged to select Specialty Hospital to continue recovering on 01/20/22  1/21/22: Patient deceased.