3/3/21,3/31/21 moderna vaccine received  CHIEF COMPLAINT COVID + increase dyspnea and oxygen needs    HISTORY OF PRESENT ILLNESS Patient is a 66 y.o. male who presents with HTN, HFrEF (EF 45%, severely enlarged LV on 10/4/2021), COPD, ESRD secondary to IgA nephropathy (s/p remain transplant 2/2014 (on CellCept/Tacrolimus/Prednisone, now CKD stage III with baseline creatinine 2.0-2.1), DVT (not currently on anticoagulation), medically complicated obesity (BMI 38), OSA on CPAP. He was diagnosed with COVID pneumonia on 11/11/2021 (symptoms started 11/2/2021). He was hospitalized locally from 11/15/2021 to 11/17/2021 for COVID pneumonia (treated with Dexamethasone, no mention of Remdesivir i CHIEF COMPLAINT COVID + increase dyspnea and oxygen needs    HISTORY OF PRESENT ILLNESS The patient is a 66 y.o. male who presents with HTN, HFrEF (EF 45%, severely enlarged LV on 10/4/2021), COPD, ESRD secondary to IgA nephropathy (s/p remain transplant 2/2014 (on CellCept/Tacrolimus/Prednisone, now CKD stage III with baseline creatinine 2.0-2.1), DVT (not currently on anticoagulation), medically complicated obesity (BMI 38), OSA on CPAP. He was diagnosed with COVID pneumonia on 11/11/2021 (symptoms started 11/2/2021). He was hospitalized locally from 11/15/2021 to 11/17/2021 for COVID pneumonia (treated with Dexamethasone, no mention of Remdesivir in outside records), complicated by CHF exacerbation (outside echocardiogram 11/16/2021 showed EF 35%) and AKI (creatinine 2.38 at discharge).     The patient was admitted on 11/15-11/17 related to COVID-19. He started to have symptoms on 11/2 of cough and dyspnea. He was PCR diagnosis on 11/11. Vaccinated Moderna 2 doses, 3/2021. He presented with progressive coughing and dyspnea. During his admission, he was found to have transient O2 requirements, received a total of 3 days of dexamethasone, his chest x-ray was consistent with COVID-19 pneumonitis.  White blood cell count of 4.4.  Hemoglobin of 11.5, platelet count of a 120.  He was able to remain stable on room our throughout his admission.  Strep pneumo negative, Legionella negative, and sputum culture were all in process at the time of discharge.  He was recommended to hold his Prograf and losartan.  He was started on aspirin and atorvastatin because TTE showed again severely increased LV size, new EF of 35% down from 40%, comment on inferior posterior wall abnormality with global LV hypokinesis. Cardiology appreciated recommend not grossly changed and started on medications. He was discharged home.    He presented to ED with progressive dyspnea and notable hypoxia on home pulse ox at 80. He was found to have acute hypoxemic respiratory failure (increasing needs from 3 L to 6 L supplemental O2 in ED).  And initial laboratory hemoglobin 12.1, hematocrit 35.7, platelets 150, white blood cell count 12.8, sodium 137, potassium 5, chloride 108, bicarb 15, and gap 14, BUN 68, creatinine 2.64, calcium 8.7, glucose 172, lactate 1.2 initial troponin 61, repeat troponin at 2 hours 59 with a negative to not changing.  D-dimer 4943.  Her chest x-ray not significant change from 06/01/2021 no focal consolidations or pleural effusions.  No pneumothorax. Enlarged cardiomediastinal silhouette. He is admitted for further evaluation treatment.   He was seen in his room.  He endorses shortness of breath that is made worse with movement.  He denies any chest pain, nausea, vomiting and diarrhea constipation or urinary complaints.  He does endorse feeling extremely fatigued.  He did report having a fever at the hospital of 100.5 but since has not had no fevers or chills.  Walking exacerbates his shortness of breath and makes his oxygen sat decreased.  At this time he denies any needs.