Age: 29.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Somnolence, Tremor, Vomiting
Clinical narrative: 5/15/21 @1200: Gammaplex IV infusion started 1320: pt rang call bell for assistance, RN entered room to see pt shaking uncontrollably, pt reports that he is not feeling well, infusion stopped, and PIV flushed, VS obtained BP: 95/66 HR: 104 Temp: 100 RR: 24, Anaphylaxis kit retrieved, DON on phone assisting with walking through Anaphylaxis reaction needs/protocol 1325: 25mg (0.5mL) of Diphenhydramine given via SIVP, PIV flushed with 3mL NS post Diphenhydramine SIVP, manual BP taken at this time BP reading of 120/78 but really hard to obtain an accurate BP d/t pt shaking, Temp: 100  RR: 23, pt continues to shake, hands are cold to touch, finger tips are white with no cap refill noted, purple areas noted around pts knuckles at this time, pt reports that his feet feel tingly at this time and possibly his fingers, states that his back has a warm sensation and that he has a light feeling, pt reports feelings of being nauseated, garbage can provided for patient 1340: no improvement noted from 1st Diphenhydramine dose given, 2nd dose of 25mg (0.5mL) Diphenhydramine given via SIVP at this time, 3mL NS flushed post med, Acetaminophen 325mg x2 tabs that was dispensed for pre-med that pt declined to take was administered PO at this time, BP: 110/64  HR: 104  Temp: 101  RR: 23, continued body shakes noted, hands continued to be cold to touch with fingertips being white noted, no cap refill noted, purple areas still noted around knuckles of hands, pt still reports a warm sensation to his back, pt communicating with eyes closed most of the time, face coloring is pale 1345: pt reports that he feels like he is going to vomit at this time, pt vomited x 3 times into garbage can, 500mL Normal Saline bag per Anaphylaxis order begin at this time, rice pack heated and provided to pt for hand warming, hands continue to be cold to touch, pt continues to keep eyes closed, face continues to be pale 1347: pt reports feeling a little better at this time, lungs clear in all lobes bilaterally to auscultation, tachycardia noted via palpitation and auscultation, pt states at this time that his back does not feel as bad, color is starting to return to pt face at this time, hands continue to be cold to touch with white fingertips noted 1350: BP: 114/72  HR: 100  Temp: 101.9  RR: 20, pt breathing has decreased, pt reports that he feels like he is feeling better, pt discussed with me again that his provider stated that there was not enough information on time frame in between getting the COVID vaccine and his infusion, he also went on to report that he also spoke with another provider about getting the COVID vaccine and his infusion and that provider gave him the CDC website for him to read about the recommendations as well, he stated that both his provider and the CDC website stated that there was no recommended interval between the COVID vaccine and IVIG 1358: BP: 118/68  HR: 90  Temp: 101.7  RR: 18, color returned to face at this time, cheeks flushed, hands continue to be cold to touch but color have started to return to fingertips at this time, cap refill noted at 4 seconds, pt reports that he thinks he is feeling better at this time, states he feels that his speech is a little slower than normal, no slur noted, pt eyes are open and pt is alert, improvement in VS noted 1410: BP: 106/64  HR: 96  Temp: 101.7  RR: 18, pt reports feeling much better at this time, pt is holding conversation well and without difficulty, pt denies feelings of nausea, more color return noted to pt fingertips, cap refill noted of 3 seconds, pt reporting feelings of being drowsy at this time, reports that his back feels normal 1420: 500mL NS bag completed, pt reports at this time that he does not wish to restart his IVIG and asks if he can stay in the AIS for a little while because the Benadryl is making him super tired, pt reports that he does not have anyone that could come and drive him home, pt assured that he can stay in the AIS with RN as long as he needs 1445: BP: 104/56 HR: 106 Temp: 101.8 RR: 20, pt resting calmly, eyes were closed upon entering the rm, pt states he feels much better still, denies any new or concern symptoms at this time, states that he is just really tired, fingertip coloring has returned, cap refill less than 3 seconds noted, lungs clear to all lobes bilaterally 1500: pt resting calmly, pt opens eyes upon entrance into pt rm, pt continues to report feeling better just tired, pt denies any needs at this time 1515: no changes noted with pt, continues to rest calmly in recliner in room with eyes closed, opening eyes when rm is entered 1540: pt up to restroom 1545: BP: 104/63  HR: 102  Temp: 101.3  RR: 18, pt reports that he is feeling much better, he reports not feeling as drowsy now and that he feels okay for him to drive home, he denies any new symptoms, pt was encouraged to take Tylenol 2 tabs Q4-6 hours for temperature and body aches for the next 24 hours, pt was educated on contacting provider for further IVIG needs and rescheduling, pt educated on going to the ER if symptoms return, pt also educated on monitoring temperature at home 1550: PIV removed with tip intact noted, pt stabilized, all color has returned to hands, pt holding conversations without difficulty 1555: pt escorted out of AIS