Pfizer Dose 1 8/16/21 (EW0179) COVID Positive 4/1/22  4/1/22: Patient is a 36-year-old female with past medical history of untreated hepatitis-C and polysubstance abuse (marijuana, heroin, methamphetamine, cigarettes).  She was admitted to the hospital yesterday for sepsis secondary to community-acquired pneumonia verses possible left upper extremity cellulitis in the location that she was injecting heroin verses possible endocarditis given her history of daily IV drug use.  Despite antibiotics and aggressive hydration, the patient continued to have worsening hypotension and eventually developed septic shock and was transferred to the ICU for pressor administration.  She then signed out AMA because she felt anxious and wanted to smoke a cigarette.  She came back within a few hours because she felt very weak.  She denies any changes that occurred in the few hours that she was outside of the hospital.  Her biggest complaints at this time arm weakness and headache.  She denies using any drugs while she left the hospital.  Please see yesterday's history attached below as it is unchanged per patient report.  Patient is a 36-year-old female with past medical history of untreated hepatitis-C, daily heroin use, and daily methamphetamine use.  She states that her daughter was taken away from her about 9 months ago and she has been on a downward spiral ever since.  She is using injection drugs daily.  She is not being treated for her hepatitis-C.  She would like to get sober, but this has been a challenge for her. She presented on 03/31/2022 with chief complaint of fever, sore throat, sweating, chills, and diffuse muscle aches.  She also notes that she has swelling and redness in her left upper extremity where she has been shooting up. She denies any chest pain or shortness of breath.  She did admit to neck pain, but states that she basically has pain everywhere.  Her symptoms began on 03/26/2022.  In the emergency department, patient's temperature was as high as 104.7° F. She was also tachycardic with a rate as high as 122. She was otherwise maintaining adequate saturations on room air and had normal and stable blood pressures.  Chest x-ray was notable for possible pneumonia in the left lung base.  Blood cultures and throat culture were obtained. Her lab work was otherwise notable for lactic acid of 2.4. No leukocytosis was noted.  Influenza and group A strep testing was negative.  COVID-19 testing, pregnancy test, and UA were pending at time of admission.  Patient was administered vancomycin, Rocephin, Tylenol, ibuprofen, Zofran, and normal saline for management of her sepsis. She denied alcohol use.  She does smoke cigarettes.  Family history was reviewed and is noncontributory.  4/3/22: Patient was admitted with very high spiking fevers, left upper extremity cellulitis and endocarditis with very elevated inflammatory markers. Blood cultures were positive, patient was continued on IV Vancomycin. Plan was to have the pateint evaluated by Infectious Disease and possibly have a TEE. Second set of blood cultures was also starting to turn positive. The source is likely the IV drug use that the patient continues to struggle with. Patient was found in the ICU is be using/snorting a brown power substance that was felt by all parties to be heroin, which the patient eventually did admit to. The entire team/staff did our best to help ease the patients worries about being in the hospital but she continue to be adamant that she wanted to leave the hospital. Patient left AMA the afternoon of 4-3-22.