Pfizer Dose 1 3/19/21 (ER8730) Pfizer Dose 2 4/9/21 (EW0153) Pfizer Dose 3 10/24/21 (lot NA) COVID Positive 1/10/22  1/10/22: Patient is a 65-year-old male with past medical history of hypertension, hyperlipidemia, gout, and obesity who was diagnosed with small cell carcinoma of the lung last year presents with neutropenic fever as well as multiple black sores which have progressed over the last 24 hours.  History is obtained from chart review as well as discussion with the patient and the ED provider.  Patient does have a history of a ischemic stroke and was on Eliquis but no longer takes it.  He underwent a lung biopsy on October 14th of last year which returned with small cell carcinoma.  He had a port placed and has been receiving chemotherapy since that time.  He does follow medical facitly for his cancer treatment.  He is currently receiving chemotherapy with Carboplatinum and etoposide and last treatment was approximately 2 weeks ago. Patient started feeling poorly on Saturday.  Started developing fevers, chills, weakness, and a lack of energy. He then developed some lesions to his left arm and in his groin area, he was seen by his oncologist today who recommended he come to the ER for admission for neutropenic fever.  He has never had these lesions before.  He does have a slight cough with mild shortness of breath.  He is not having any chest pain or abdominal pain.  Did have issues with constipation but now had loose stools after taking milk of magnesia.  He was found to be severely neutropenic as well as thrombocytopenia and will be receiving 1 unit of platelets.  1/14/22: A 65-year-old man with a history of squamous cell carcinoma of the lungs, on chemotherapy, hypertension, dyslipidemia, gout and obesity who presented to the emergency room with complaints of fever and multiple skin lesions.  Patient had complaints of fever, chills, slight cough and multiple skin lesions.  On presentation to the emergency room, patient was febrile, blood pressure was normal.    Examination of skin consistent with hemorrhagic lesions concerning for folliculitis/ecthyma.  Laboratory workup on presentation had revealed neutropenia, acute kidney injury and thrombocytopenia and anemia.  Blood cultures collected, patient was started on IV ceftazidime and vancomycin.  Receive Neupogen.  Patient received 2 units of packed red cell and platelet during this admission.  Patient is vaccinated for COVID-19 infection, COVID-19 screen returned negative.  His x-ray is clear, he has no pneumonia, he is not requiring oxygen.  Infectious disease specialist was consulted to assist with management.  Blood cultures return negative, skin lesion was assessed by Infectious Disease specialist assessments of folliculitis complicated by thrombocytopenia and hemorrhagic lesions.  His oncologist was also consulted.  Patient had resolution of neutropenia.  He also had resolution of his fevers.  CBC revealed improving thrombocytopenia and anemia.  He also had resolution of acute kidney injury.  Patient remained asymptomatic for COVID-19 infection.  His skin lesions healing.  He has been cleared for discharge by the Infectious Disease specialist, he is being discharged home on oral antibiotic therapy.  For outpatient follow-up with Oncology and Infectious Disease specialist