Age: 62.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Fatigue, Influenza like illness, Injection site erythema, Injection site induration, Injection site mass
Clinical narrative: Chief Complaint Patient presents with ? Rash     red and swollen area located on right deltoid area X 3 days ago after receiving the shingrix vaccine   Patient ID: Patient is a 62 y.o. female.    HPI Here for complaints of a rash since 3 days ago after receiving the shingrix vaccine.    Rash: -Received first shingrix 4/26/19 about 1-2 pm, at pharmacy, R deltoid  -Notes rash at injection site day after vaccine which has been enlarging since -No fevers or chills but did have episode of diarrhea that day after vaccine.  Was more red, improved after ice application -No previous reactions to vaccines.    Advanced Health Care Directive on file from 6/28/2016. Considering changing one of the questions about organ donation.    Patient Active Problem List Diagnosis ? Esophageal reflux ? Bipolar disorder (HCC) ? Genital herpes ? Organic mood disorder ? Attention deficit hyperactivity disorder (ADHD), predominantly inattentive type ? Panic attacks ? Chronic obstructive pulmonary disease (HCC) ? OSA (obstructive sleep apnea) ? Osteopenia ? Arthritis of knee, right ? History of cardiovascular stress test ? H/O ETOH abuse ? Anxiety ? Obesity (BMI 30-39.9) ? Pulmonary nodule ? Neck pain ? Right knee DJD ? Active advance directive on file     Medications Taking Outpatient Medications Marked as Taking for the 4/29/19 encounter (Office Visit) with MD Medication Sig Dispense Refill ? ACYCLOVIR ORAL Take 1 tablet by mouth as needed.     ? albuterol (PROVENTIL HFA, VENTOLIN HFA) 90 mcg/actuation inhaler Inhale 2 puffs into the lungs every 4 (four) hours as needed. 1 each 3 ? albuterol (PROVENTIL, VENTOLIN) 0.083 % nebulizer solution Take 1 vial (2.5 mg total) by nebulization every 4 (four) hours as needed for wheezing. (Patient taking differently: Take 1 vial by nebulization every 4 (four) hours as needed for wheezing or shortness of breath.  ) 3 Box 3 ? CALCIUM CITRATE-VITAMIN D3 ORAL Take 1 tablet by mouth daily.     ? conjugated estrogens (PREMARIN) vaginal cream Insert vaginally 2 (two) times a week. Use 1 gram pv 2x a week (Patient taking differently: Insert 1 g vaginally 2 (two) times a week. Use 1 gram pv 2x a week ) 42.5 g 3 ? escitalopram oxalate (LEXAPRO) 10 MG tablet Take 10 mg by mouth every morning.        ? mometasone-formoterol (DULERA) 200-5 mcg/actuation HFAA inhaler Inhale 2 puffs into the lungs 2 (two) times a day. 3 Inhaler 3 ? multivitamin capsule Take 1 capsule by mouth daily.     ? omeprazole (PRILOSEC) 20 MG capsule Take 20 mg by mouth every morning. Take 1/2 to 1 hour prior to eating.     ? potassium/magnesium (MAGNESIUM-POTASSIUM ORAL) Take 1 tablet by mouth daily.          Review of Systems  Constitutional: Negative for chills, diaphoresis and fever.  Gastrointestinal: Positive for diarrhea.  Musculoskeletal: Negative for arthralgias and myalgias.  Skin: Positive for color change and rash (localised right deltoid redness).    Objective:   Vitals Vitals:   04/29/19 1314 BP: 132/80 BP Location: Right arm Patient Position: Sitting BP Cuff Size: Adult Pulse: 71 Temp: 98.3 °F (36.8 °C) TempSrc: Oral SpO2: 97% Weight: 87.8 kg (193 lb 8 oz)      Physical Exam  Constitutional: She appears well-developed. No distress.  Musculoskeletal: Normal range of motion.  Skin: She is not diaphoretic. There is erythema.  R deltoid light pink erythema  measuring 9 x 7 cm. Not warm or fluctuant  mild tenderness of deltoid, no swelling Assessment/Plan:  1. Local reaction to influenza vaccine, initial encounter Local skin reaction. Suspect will subside in size. No fever to suspect cellulitis and not red hot or swollen.  Vaccine report.  Ice, ibuprofen. FU prn if worse Can get second injection in 2-4 months