Pfizer Dose 1 7/22/21 (lot NA) Pfizer Dose 2 8/20/21 (lot NA) COVID Positive 2/1/22  2/2/22: Patient is a 59-year-old female with a past medical history significant for atrial fibrillation post CABG in 2019 with spontaneous conversion into sinus rhythm not currently on anticoagulation (she has not had any recurrence of atrial fibrillation since this episode until today), CKD stage 3, COPD, CAD s/p CABG, hyperlipidemia, impaired fasting glucose, obesity, tobacco use.  The patient presents to the ED today with complaints of dyspnea that has been ongoing for the last couple of days.  The patient states on Sunday she began feeling ill, having lightheadedness, dizziness, productive cough with green sputum, shortness of breath, fever.  The patient denies any chest pain, nausea, vomiting, diarrhea.  The patient currently follows with doctor at pulmonology associates for COPD, she self stopped taking her Advair due to feeling it was not helping her in any way.  The patient currently uses albuterol inhalers as needed.  The patient states she has been using her albuterol inhaler as needed the last couple of days with no relief of her symptoms.  She states she has not tried any other over-the-counter medications for symptom management.  She is vaccinated against COVID-19, has not received her booster vaccination yet but is not due.  She denies any alcohol abuse or illicit drug abuse.  The patient is a current everyday smoker, however states she has not had a cigarette since falling ill on Sunday. Prior to that she was smoking 6-8 cigarettes per day.   Upon arrival to ED patient's temperature is 101.0°, heart rate 68, respirations 26, pulse ox 78% on room air, blood pressure 136/57.  The patient was placed on 9 L of oxygen via Oxygen Mask to maintain O2 saturations greater than 90%. Chest x-ray reveals findings suspicious for right lower lobe pneumonia.  Chest CT to rule out PE still pending. Patient's laboratory findings are significant for glucose 175, creatinine 1.07, D-dimer 1.26.  The patient tested positive for COVID-19 in the ED.  Patient's influenza a and B tests are negative.  Patient has no leukocytosis.  ABGs show low PO2 of 64. The patient received an hour long albuterol nebulizer treatment, 30 mg IV Toradol, 1 g p.o. Tylenol, 500 mg IV azithromycin, 1 g IV Rocephin, 2 g IV magnesium sulfate, 125 mg IV Solu-Medrol, and 1 L IV normal saline in ED.   The patient was seen and examined at the bedside in the ED.  The patient continues to be short of breath despite being on 7 L oxygen via Oxygen Mask.  Patient's O2 saturations are greater than 90%.  The patient has significant conversational dyspnea.  The patient does not have any wheezes on examination.  She is significantly tachycardic in the ED, in atrial fibrillation with heart rate in the 170s to 180s.  Patient has not received any medication for management of AFib with RVR.  The patient states she has not had any episodes of atrial fibrillation since after her CABG in 10/2019. She follows with Doctor.  2/7/22: The patient presented to the hospital with cough and shortness of breath and she was hypoxic requiring oxygen through the face mask, had bilateral wheezing and crepitation on the physical exam and she was mildly dyspneic, her COVID-19 test came back positive, CRP significantly elevated 17 with positive D-dimer, CT chest angiogram negative for PE and show bilateral pulmonary infiltrates with nodules, the patient started on Actemra, dexamethasone and remdesivir and have been able to taper her oxygen requirement down until she did not require any oxygenation on the day of discharge.  She had hyperglycemia require insulin to control her blood glucose specially she was on systemic steroid, her hemoglobin A1c 6.7% show controlled blood glucose.  The patient had episodes of symptomatic AFib with RVR require IV amiodarone then her rhythm converted to sinus, her CHADS VASC score is 3, started on Eliquis and beta-blocker.  She had echocardiogram show nonvalvular AFib with EF 55% and no indirect signs of pulmonary hypertension or hypokinesia.