Patient enrolled in a study received study medication (Janssen ad.26CoV2 vaccine) on 10/17/2022. Patient brought by family member to ED on 2/12/2023 for worsening generalized weakness. Patient stated he had generalized abdominal pain at night over the past few weeks. Of note, the patient has been previously hospitalized for generalized weakness and most recently was hospitalized from 1/16/2023 to 2/6/2023 for worsening bilateral lower extremity edema with discharge diagnosis of anasarca and acute coronary heart failure. At discharge he required supplemental O2 5 L NC and discharged to rehab facility on 2/6/2023. On 2/9/2023 he was diagnosed with aspiration PNA there and started on augmentin + azithro. 2/12/2023, patient denied any vomiting. He said to have had diarrhea but denies any blood in his stool. He denies any blood in his urine. He was diagnosed with a pneumonia over a week ago prior to 2/12/2023 and has been on antibiotics for it (augmentin and azithromycin). Per the patient's daughter she was discussing with the nursing facility and the patient's physician about his worsening kidney function on the lab work and his symptoms and was advised to come to the emergency department. He denies any fevers. He denies any current chest pain. He says he has had generalized weakness as well recently. He has also noticed increased bilateral left swelling recently. HOSPITAL COURSE 2/12/2023 Chest x-ray showed worsening pulmonary edema, enlarging bilateral moderate-sized pleural effusions and right lower lobe consolidation/atelectasis in the setting of calcified inspissated secretions concerning for chronic aspiration pneumonia US with doppler of the right kidney transplant IMPRESSION: 1. Right lower quadrant renal transplant with patent vasculature and normal arterial resistive indices. 2.. Multiple shadowing echogenic foci in the upper pole of the transplant kidney. No hydronephrosis. When correlated with subsequent follow-up CT abdomen/pelvis on 2/12/2023, there is air in the collecting system, compatible with emphysematous pyelitis. Finding may be due to recent instrumentation in setting of Foley catheter in place versus an infectious/inflammatory process. Recommend attention on follow up. 3. Upper limits of normal to borderline increased echogenicity of the transplant kidney, mildly improved from prior exam CT of the abdomen and pelvis without IV contrast showed no obvious acute inflammation of the small bowel, nonspecific fluid/edema adjacent to the cecum and appendix which did not appear to be consistent with acute appendicitis, bibasilar airspace opacification and right lower lobe consolidation concerning for aspiration pneumonia, significant volume overload with pulmonary edema, sizable bilateral pleural effusions, and anasarca. Discharge summary. Patient was admitted to internal medicine 2/12/2023 for acute on chronic diastolic heart failure exacerbation secondary to inadequate diuresis. Patient responded well to IV Lasix 60 mg, and his Augmentin 500 mg was continued for community acquired pneumonia. Renal transplant was consulted for worsening renal function and recommended dialysis three times per week with plans to contact his local nephrologist on discharge. Patient discharged to inpatient rebab facility 2/16/2023. Principal diagnosis Acute Chronic Diastolic (Congestive) Heart Failure. Please note this is an ongoing previous noted and study site principal investigator has given casualty as not study related.