11/27/2019 Patient's wife called in. states that patient developed low BP and confusion. He is admitted to Medical. Wife states that pt received Shingle vaccine and Pneumonia vaccine on 11/25. She was informed by hospital that he had a reaction to one and is also being treated for infection right arm. Area is red and hard. He is getting IV antibiotics. I advised her to keep us posted and to call her Pact RN when discharged. She expressed understanding,  #See Continuation Page (Right Arm)  Initial Diagnosis: Cellulites Delirium Encephalopathy  Discharge Diagnosis on 11/30/2020 * See Continuation Page Below  Discharge Summary Admit Date   Admission Date Time: 11/27/19 2210 Anticipated Discharge Date 11/30/19Final Dx/Problem List   1. Encephalopathy Sepsis secondary to cellulitis of the right upper extremity at the site of vaccine injection, will consult ID, on IV Zosyn, obtain a duplex of the right upper extremity, blood cultures no growth Fever ongoing follow culture result Acute metabolic encephalopathy, secondary to sepsis resolved Leukocytosis monitor CBC, white count trending down Diabetes type 2 resume metformin continue sliding scale Chronic pain will resume home medication Acute kidney injury resolved Diabetic neuropathy Hyper tension continue home medication BPH Patient Problems Reviewed: Yes Chief Complaint/HPI Altered mental status, fever Reason for Admission 63-year-old male past medical history significant for chronic pain for which he follows up with pain management, type 2 diabetes diabetic neuropathy hypertension hyperlipidemia BPH received pneumococcal and varicella zoster vaccine on Monday.  Starting Tuesday he started having a low-grade fever headache and overall not feeling right and some GI symptoms.  He presented to the emergency room for evaluation of altered mental status and fever by his wife.  CT of the head no acute intracranial process chronic changes including multifocal bifrontal and left anterior temporal encephalomalacia and gliosis.  Patient was given Narcan with some relief per report.  He was admitted to floor for further evaluation.  At home patient is on baclofen, Ativan, and trazodone, Norco.  All opioids, sedatives hypnotics were put on hold.  Seen by neurologist.  Symptoms suspected due to sepsis.  Neurology signed off.  For leukocytosis and fever he was started on IV Zosyn for cellulitis of the right upper extremity at the site of injection of Prevnar.  Duplex of the right upper extremity negative for DVT and SVT.  Seen by ID.  Overall his symptoms did resolve.  He remained afebrile 24 hours.  His leukocytosis did resolve at the time of discharge.  Patient discharged on 7 days of Augmentin for cellulitis right upper extremity.  Follow-up with primary care physician for further recommendation.  On the day of discharge Page 1 of 6  Medication List  ASPIRIN 81MG EC TAB  RX#15592450  TAKE ONE TABLET BY MOUTH EVERY DAY (WITH FOOD)  DIPHENHYDRAMINE HCL 50MG CAP  RX#15592463  TAKE ONE CAPSULE BY MOUTH AT BEDTIME AS NEEDED FOR SLEEP  GABAPENTIN 400MG CAP  RX#15592464  TAKE TWO CAPSULES BY MOUTH THREE TIMES A DAY  METFORMIN HCL 1000MG TAB  RX#15592470  TAKE ONE TABLET BY MOUTH TWICE A DAY WITH MEALS (AVOID ALCOHOL) IBUPROFEN 800MG TAB  RX#15592477  TAKE ONE TABLET BY MOUTH THREE TIMES A DAY AS NEEDED FOR PAIN (WITH FOOD)  HYDROCODONE 5MG/ACETAMINOPHEN 325MG TAB  RX#1337211  TAKE 1 TABLET BY MOUTH EVERY 12 HOURS AS NEEDED FOR PAIN (DO NOT TAKE MORE THAN 4000 MG OF ACETAMINOPHEN PER DAY)  METOPROLOL SUCCINATE 100MG SA TAB  RX#15592472A  TAKE ONE-HALF TABLET BY MOUTH EVERY DAY  ATORVASTATIN CALCIUM 40MG TAB  RX#15592461A  TAKE ONE-HALF TABLET BY MOUTH AT BEDTIME  PANTOPRAZOLE NA 20MG EC TAB  RX#15650020  TAKE ONE TABLET BY MOUTH EVERY MORNING, ON AN EMPTY STOMACH GERD  BACLOFEN 10MG TAB  RX#15592462  TAKE ONE TABLET BY MOUTH AT BEDTIME FOR MUSCLE SPASMS  HCTZ 25/LISINOPRIL 20MG TAB  RX#15592466  TAKE 2 TABLETS BY MOUTH EVERY DAY WITH FOOD TAMSULOSIN 0.4MG CAP  RX#15592476  TAKE ONE CAPSULE BY MOUTH AT BEDTIME  TRAZODONE HCL 100MG TAB  RX#15592485  TAKE ONE TABLET BY MOUTH AT BEDTIME FOR INSOMNIA  Allergies and Adverse Reactions Summary  02/05/2020 PneumoVax23 Encephalopathy Delirium Cellulitis  Self 07/11/1992 BANANAS  07/11/1992 CODEINE    Problems (Conditions) List Anxiety (SCT 48694002) Benign prostatic hypertrophy without outflow obstruction (SCT 254902007) Diabetes mellitus (SCT 73211009) Erectile dysfunction (SCT 397803000) Essential hypertension (SCT 59621000) Gastroesophageal reflux disease (SCT 235595009) Hyperlipidemia (SCT 55822004) Insomnia (SCT 193462001)