Age: 41.0
Sex: M
Vaccine: COVID19
Symptoms: Cyst, Facial pain, Pain in jaw, Swelling face
Clinical narrative: Patient called nurse triage line and reported FACIAL SWELLING following vaccine administration.  Received booster dose 12.22.21.  Symptoms of facial swelling started the AM of 12.23.21.  Patient reported:  "Constant 5/10 pain with facial swelling. Patient received pfizer booster 2 days ago and yesterday woke up with facial swelling mostly on the left side of his face and bilateral jaw pain. He is stating he did develop a cyst on his face after the 2nd pfizer vaccine. He rates both the swelling and pain in the moderate range. Denies any difficulty swallowing or breathing. No redness either. Patient Has tried Tylenol with moderate improvement.  Pertinent negatives include: Afebrile. No chest pain. No breathing difficulty."   Guidance provided by Provider: "Spoke with pt.  Noted swelling on left side of face, bridge of nose upon waking today.  Had 3rd Pfizer 2 d ago, otherwise no other obvious cause.  Denied swelling of lips or tongue and no SOB or wheezing.  No f/c, erythema.  Has not tried anything yet.  Recommended Benadryl 50 mg q 6 hr for next 2-3 days and APAP for pain (reported some jaw soreness) and to go to ER/911 (not UCC) if swelling spreading to mouth/airway.  Otherwise call back if not improving or worsening but not affecting airway, in which case steroids could be an option." Patient went to Urgent Care on 12.26.21 - for same complaint of facial swelling.  Description in note: "Comments: Mild swelling with erythema and tenderness over the bilateral cheeks, jaw and submandibularly from the indicated area above down.  No significant sinus pain or pressure, no tenderness over the bridge of the nose.  No area of discrete fluctuance or induration.  No streaking redness.  No edema.  No trismus.  Posterior oropharynx is without edema, swelling or erythema.  Tolerating oral secretions without significant difficulty."  Solu-Medrol was given in the urgent care he was evaluated approximately 15 minute after medication was given stating that he felt okay, about the same.  Did prescribe a steroid taper to be started tomorrow but with his history did advised that he contact his PCP for continued recommendations to coordinate care.  Advised very close monitoring of symptoms continuing the Benadryl and emergency department evaluation immediately for any new or worsening symptoms or without symptom improvement.  Patient went to ED on 12.28.21 for same facial swelling symptoms:  ER COURSE - On physical exam, patient was speaking in full sentences without evidence of vocal hoarseness, no tongue swelling, no evidence respiratory distress.  Patient was given Solu-Medrol 125 mg IM, Benadryl 25 mg IM and Pepcid 20 mg tablet.  Given clinical history of itchy rash starting day after COVID vaccination, higher suspicion for vaccination related etiology.  In the setting of patient being on Prednisone 5 mg daily chronically, I felt patient warranted being on Prednisone 40 mg x 5 days instead of the initial recommendation of Prednisone 40 mg x 2 days which patient reported the urgent care prescribed him.  Patient otherwise given script for 3 additional days of Prednisone 40 mg, and script for Benadryl and Pepcid.  Patient instructed to take Prednisone 40 mg for the next 3 days and follow the remaining tapered doses as previously prescribed.  Patient otherwise given return precautions, instructed to follow up with PCP, otherwise ambulatory and stable upon discharge