Age: 41.0
Sex: F
Vaccine: COVID19
Symptoms: Rash, Tachycardia, Throat tightness, Vomiting
Clinical narrative: o Complaint The patient is a 41 year(s) old Female complaining of o Chief Complaint Quote Patient states she got her COVID vaccine today and rapidly started feeling SOB, dizzy and feeling tired. Per EMS, patient did receive one IM of Epi. o Time Seen 02-17-2021 11:49 o Historian patient o Objective Statement 41-year-old female brought to the emergency room by EMS for allergic reaction.  Patient says just prior to arrival she received first dose of her Covid vaccination.  She said she was waiting after she received her vaccination when she began to have difficulty breathing, lightheadedness and nausea.  She was given a IM dose of epinephrine and sent to the emergency department for further evaluation.  In the emergency department, she says difficulty breathing has improved.  She said she is now having some chest pain.  She says pain is across the anterior chest, pressure-like.  She said she also feels nauseous.  Headache, throat tightening, rash, pruritus, abdominal pain, vomiting, diarrhea, dysuria, paresthesias or focal weakness.  She has never had an allergic reaction before.  Review of Systems   Constitutional: Negative for chills, diaphoresis and fever.   HENT: Negative for congestion, facial swelling and rhinorrhea.    Eyes: Negative for discharge and visual disturbance.   Respiratory: Negative for cough.  Positive for chest tightness and shortness of breath.    Cardiovascular: Positive for chest pain.  Negative for leg swelling.   Gastrointestinal: Negative for abdominal pain, diarrhea, blood in stool and vomiting.   Endocrine: Negative for cold intolerance and polydipsia.   Genitourinary: Negative for difficulty urinating, dysuria and hematuria.   Musculoskeletal: Negative for arthralgias, joint swelling and myalgias.   Skin: Negative for rash.   Neurological: Negative for speech difficulty, numbness and headaches.  Physical Exam Nursing notes and vital signs reviewed.  GENERAL: No distress  HEAD: normocephalic, atraumatic  EENT: PERRL, EOMI. Conjunctivae normal color, sclerae non-icteric; moist mucous membranes.  There is no pharyngeal erythema or edema, uvula midline no stridor, patient handling secretions with no difficulty NECK: Supple, non-tender; no meningismus  LUNGS: Patient in mild respiratory distress, tachypneic, lungs CTA. Normal air movement.  HEART: Tachycardic with regular rhythm, no murmur  CHEST: No deformity; non-tender  ABDOMEN: The abdomen is soft, and non-tender, no masses or bruits.  EXTREM: Normal ROM; no deformity, no calf tenderness. Normal pulses palpable in all extremities. There is no pedal edema.  SKIN: No rash; no diaphoresis  NEURO: Alert; normal speech and cognition; CN's grossly intact; strength grossly intact without focal deficit.  BACK: No CVA TTP. o ED Course 1250: On reevaluation, patient resting comfortably in the room.  She said she is feeling much better.  She is no longer having any difficulty breathing.  Chest pain has resolved.  Her vital signs have normalized.  She is no longer tachycardic.  CBC shows a mild leukocytosis.  CMP does show hypokalemia.  On her EKG she does appear to have some U waves.  EKG shows sinus tachycardia, no ischemic changes.  Chest x-ray unremarkable.  Potassium was repleted.  On arrival, patient was given Benadryl, Solu-Medrol, Pepcid.  She was given epinephrine at the vaccination site so no additional epinephrine was given here and at this point I do not feel she needs an additional dose.  We will continue to monitor the patient in the ED.  1520: On reevaluation, patient is resting comfortably in the room.  Her vital signs remained stable.  She is not having any symptoms.  No chest pain or shortness of breath.  We will discharge the patient home.  We will give her prescription for an EpiPen.  Discussed warnings indications to return to ED.  Told patient she should contact her primary care provider to discuss whether or not she should receive the second dose.  Patient understands and agrees with the plan.