Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Pruritus, Somnolence, Urticaria
Clinical narrative: At about 1:43PM RN overheard the client stating "I'm feeling weird" to her husband and noted the client placing her hand over her chest. The client was seated in a wheelchair. RN approached the client and asked what symptoms she was currently experiencing. The client again stated "I feel weird." RN asked the client to explain her symptoms. The client stated "I feel like my blood pressure is getting high." The client reported a history of hypertension. The client stated that she takes her blood pressure medication at night and confirmed she did take her medication last night. Vitals obtained at 1:46PM were as follows: automatic BP 156/67, HR 64, O2 98%. The client reported feeling "anxiety" then she stated "it's coming down." The client stated her systolic blood pressure was at 176 last night. The client said "when my blood pressure goes up, I take my medication." Repeat vitals obtained at 1:52PM were as follows: automatic 172/80, O2 96%, and HR 62. The client denied any other s/s of anaphylaxis. The client has a history of anaphylaxis and does own an Epinephrine injection. The client states she has not used Epinephrine in several years. Allergies include Methotrexate, Darvon, and Cipro. The client reports swelling and diarrhea after taking Methotrexate. The client reports a history of a "big brown rash" on her back during her other allergic reactions. The client states that she takes Benedryl when she experiences allergic reactions, which provides relief of her symptoms. Client has a history of hypertension and polymyositis. Client takes Metoprolol, Tramadol, Meclizine, Levothyroxine, magnesium, and vitamins.  The client was alert and oriented to person, place, time, and situation. The client stated "I feel like my pressure is going up." RN recommended repeat manual BP on the other arm. Repeat vitals obtained at 1:56PM were as follows: manual BP 152/78, HR 62, and O2 96%. The client stated when her blood pressure goes up she takes her blood pressure medication. RN educated the client that we cannot provide advice regarding personal medications. The client voiced understanding of this education. Client decided to take her personal Metoprolol 50mg PO at 1:57PM with water. The client subsequently reported "its starting to feel like pins in the back." RN evaluated the client's back where the client reported itching and noted to evidence of urticaria or hives. The client denied any other s/s of anaphylaxis. RN offered the client Diphenhydramine. The client denied the medication. Repeat vitals obtained at 2:02PM were as follows: BP 158/82, HR 64, and O2 96%. The client reported itching on her back along the band of her bra. RN noted mild urticaria on the right lower side of the client's back. RN recommended administration of Diphenhydramine 50mg PO. The client elected to proceed. RN educated the client regarding Diphenhydramine including drowsiness. The client voiced understanding of this education. The client denied any shortness of breath, itchiness in the throat or tongue, or swelling of the throat or tongue. The client consumed 50mg Diphenhydramine in oral solution PO at 2:09PM with water. Vitals obtained at 2:10PM were as follows: BP 160/89, HR 63, and O2 98%. The client reported "itchiness just on my back a little bit and no symptoms of increased blood pressure." The client subsequently reported "pressure in my chest that comes and goes." RN activated EMS at 2:13PM. Repeat vitals obtained at 2:19PM were as follows: manual BP 165/86, O2 97%, HR 60. The client reports feeling "sleepy." The client denied any other s/s of anaphylaxis. EMS assumed care at 2:21PM. The client denied EMS transport AMA at 2:25PM. The client left the vaccination site in a wheelchair with her husband. The client stated she was going to seek care at the hospital. The client did not state which hospital.