Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Anaphylaxis prophylaxis, Chest discomfort, Cough, Dyspnoea, Heart rate normal
Clinical narrative: Patient received vaccine at 10AM and waited 15 min then exited the site without any complaints or stated rxn.   Per the patient, after she had left the site, she began to feel short of breath and instructed her husband to drive her back for evaluation.  Patient complained of intermittent tightness in her upper chest and brief periods of difficult breathing.  Report below per physician on-site.   4/19/2020 11:48am  This morning, I attended a 43 year old accompanied by her significant other. They returned to the Center after she received her 1st Moderna Covid-19 vaccination here about 40 mins prior. She complained of an intermittent tightness in her upper chest and felt she was having brief periods of trouble breathing. She denied tongue swelling, wheezing, pruritis, or rash. She did not take any medications after her vaccination. She noted a distant (20+ years ago) of a food allergy to ?seeds? that required transport to a hospital and what sounds to me that she had epinephrine administered at that time. She has not had another severe allergic reaction since but notes seasonal allergies and takes Allegra and uses an inhaler PRN. She does not have these medicines with her. On exam, she is sitting on the cot in the EMS tent. She is in no acute distress and is speaking in full sentences. There is no urticaria, no tongue swelling, no stridor, and no voice changes. She is not tripoding and there is no increased work of breathing. Her left radial pulse is strong, steady, and not tachycardic nor bradycardic. Her pulse oximetry was 95-98%. I informed her that at the time, I feel that close observation in warranted and she and her significant other agreed to stay to be observed. Shortly after this, she was observed to sit up, hold her upper chest and cough with slight stridor. This only lasted a few seconds and then resolved. Several minutes later, this happened again. I informed her that I felt that caution was advised with her history of a severe allergic reaction and intermittent upper airway signs. I recommended that she be observed in a hospital setting for her safety. She agreed and the Fire Department was contacted through 911.  When the paramedics arrived, she stated she was feeling much better. There were no longer any upper airway signs/symptoms. She declined transportation by ambulance to the hospital. I observed her for an additional ~10 mins and she continued to be asymptomatic. She was again offered transport to the hospital by ambulance and again declined. She sated she would like to go home with her significant other who would be with her to watch for any worsening signs//symptoms. I strongly recommended that if developed any upper airway signs such as feeling her throat is closing, tongue swelling, difficulty breathing, or any other concerning symptoms she should immediately call 911 as these may indicate a life-threatening emergency. She and her significant other indicated that they understood my instructions and agreed to abide by these recommendations.  I asked her to discuss her reaction with her primary provider before receiving another dose of a Covid-19 vaccine. Medical Director