Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Tryptase, Urticaria, White blood cell count increased
Clinical narrative: Within a minute, there was a different taste in my mouth. Shortly after, began to feel incredibly hot, flushed, burning, and tingling throughout body. Throat and tongue also became tingly. It was like a wave that moved through my body. After waiting it for a few minutes to see if there was improvement, there was a strong ?wave? that came with all of the above, but my heart started racing with palpitations. HR was 120. The heat feeling became worse. Would describe the feeling as a CT contrast feeling, including the feeling of voiding or heat/burning of the bladder. Tongue and throat more tingly. A few minutes later the feeling all became stronger and this is what became the strongest ?wave? of the feeling with my heart beating incredibly fast. The heat/burning/tingling (including the mouth and tongue) were severe. HR 148. Nauseated and lightheaded/dizzy. Transferred to ED.   In the ER, epi was administered due to the persisting flushing/burning of the skin/and tingling of the throat and tongue with tachycardia. IV fluid bolus, Benadryl, and zofran were also administered. Tryptase was obtained approximately 35 - 45 minutes after injection. Tryptase 10.8. Improvement in all symptoms following epi/benadryl.    Was monitored in the ER and within approximately 1.5 hours, the burning feeling returned, but was centralized in my core (felt internal versus skin). Abdomen/chest area with intermittent burning. At approximately 2-3 hours, the tingling began to return. Slight tingling of the tongue, lip. The burning feeling continued to worsen, now back to the skin as well as the core, and additional benadryl was administered in addition to solu-medrol. Prior to this, the attending physician was concerned that my heart rate remained elevated into the 110/120s 3 hours after the epi administration and she recommended transfer to an adult facility for further evaluation. Due to the burning in my chest, EKG was obtained. Sinus tachycardia. Slight chest tightness, duoneb provided. Had not taken inhalers throughout the day and felt similar to tight chest/difficulty getting deep breath in relation to asthma. Relief after the second dose of benadryl and duoneb.   BP remains elevated from shortly after vaccine administration.   Transferred to ER at 4-5 hours post vaccine. En route to facility, HR 130s and BP lower (90s/60 and 90s/50s) - Medic did not think was accurate BP. At ER, cardiac rule out completed with additional EKG due to development of some chest pains and return of core burning sensation as well as ongoing tachycardia. EKG remains sinus tach, troponins normal. Requested anxiety medication to see if that would help with heart rate. Low dose ativan given. Minimal change to resting heart rate, still elevated. Also received 4 baby aspirin and tylenol for extreme headache. Oxygen saturations  were 97-100%. Oxygen saturation at ER was 90-93%. Attending physician not concerned with going home and saturation still being low 90s as long as there was no shortness of breath. Discharged home with methylprednisone 4 mg 6 day pack and pepcid prescriptions. Resting HR was low 100s at time of discharge. Instructed to continue with antihistamines every 6 hours. DX anaphylactic reaction.    Husband checking on me while sleeping, oxygen saturation in sleep 89-91%. After awakening, saturation improved to 94-95%.   At home, burning skin and core feelings persisted. Tingling of the throat/tongue/lips continued to be intermittent. Antihistamines helped to relieve symptoms. 26-28 hours after vaccine, symptoms were very strong, was suffering from extreme burning and tingling of the mouth/lips. Considered return to ER but oxygen saturation was okay. HR elevated. 125 at rest. ER attending physician encouraged me to try to not use the prednisone packet unless necessary/return of symptoms. Started prednisone with the return of symptoms.    Continued on routine Benadryl until myoclonic jerking became too pronounced, discontinued on 12/25/2020 and changed to hydroxyzine. Jerking remained but improved and was less bothersome. Continued taking daily dose of Claritin, daily pepcid, daily aspirin. Hives developed 12/25/2020.   Return to ER on 12/29/2020 as the jerking was intense and felt to be in chest along with palpitations. EKG and troponin was good, only notable thing physician reported on labs was an elevated WBC count. Did not discuss jerking.    To PCP on 1/4/2020 - discussed adverse reaction. Continued problems after vaccine include: intermittent tachycardia (low 100s at rest occasionally vs norm of 70s/ low 80s), higher heart rate when active, burning skin (feels similar to bad sunburn feeling), random pains and occasional brief numbness/tingling/tremoring in muscles/extremities, jerking (continues to improve - recommended change off of benadryl/hydroxyzine to zyrtec), increased need for inhaler, bubbling sensation in left lower abdomen. It does feel as if it comes in waves.    Burning sensation, internal tremors of left upper thigh, and intermittent tachycardia continue, 1 month post vax.   Antihistamines do help, but discontinued due to jerking. Continue on daily claritin.