Age: 32.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Pruritus, Urticaria
Clinical narrative: Pt received second dose of Pfizer vaccination at 0910. At 0925, pt notified staff of intermittent feelings of shortness of breath and lightheadedness. Pt verbalized she had no intake for the morning was given apple juice and animal crackers. At 1015, pt reported to staff of continuing intermittent feelings of lightheadedness, shortness of breath and itching on the legs. Pt was transported to private area for further assessment via wheelchair and assisted to lie down on massage table. A provider on duty assessed pt at 1015 and administered Epipen at 1020 for potential allergic reaction. Pt reported to have taken Lorazepam (dose unknown) prior to appointment at 0905. Symptoms were discussed with pt and agreed to have EMS transport to ED for further monitoring. EMS was called and they transported pt to WW ED.  0925 Vitals: BP-108/64, P-64, O2-97%, Resp-20 1015 Vitals-BP-104/60, P-78, O2-100%, Resp-20 1035 Vitals-BP-124/68, P-80, O2-100%, Resp-20  Admin: Epinephrine (EPIPEN) 0.3mg/0.3 mL injection R thigh  transported to ED next to clinic.  ED COURSE & MEDICAL DECISION MAKING:   11:10 AM I met with the patient, obtained history, performed an initial exam, and discussed options and plan for treatment here in the ED. I was wearing PPE including N95 mask and face shield.  11:19 AM Paged allergist. 11:40 AM I discussed the patient with allergist from Fairview. He does not recommend any additional labs or treatment for the patient. 2:12 PM I rechecked on the patient and she is feeling better. We discussed the plan for discharge and the patient is agreeable. Reviewed supportive cares, symptomatic treatment, outpatient follow up, and reasons to return to the Emergency Department. Patient to be discharged by ED RN.    Pertinent Labs & Imaging studies reviewed. (See chart for details) 32 y.o. adult presents to the Emergency Department for evaluation of allergic reaction.  Had onset of symptoms within a few minutes of receiving her second Pfizer COVID-19 vaccination today.  Symptoms seem consistent with allergic reaction including itching, hives, feeling lightheaded, nausea, and some abdominal cramping.  She was given an EpiPen prior to arrival and brought here by EMS.  There she was also given Benadryl, Solu-Medrol, and Pepcid.  Other than some mild itching, did not have any return of other symptoms.  Given prescriptions to continue with Claritin, Pepcid and prednisone.  Also prescriptions for EpiPen was provided.  Did briefly discuss with the allergist on call.  No additional recommendations at this time.  I do recommend that she follow-up with an allergist sometime the next few weeks.  She was advised to return to the emergency department for any new or worsening symptoms or other concerns.   At the conclusion of the encounter I discussed the results of all of the tests and the disposition. The questions were answered. The patient or family acknowledged understanding and was agreeable with the care plan.      MEDICATIONS GIVEN IN THE EMERGENCY: Medications methylPREDNISolone sod suc(PF) injection 125 mg (Solu-MEDROL) (125 mg Intravenous Given 2/10/21 1135) diphenhydrAMINE injection 25 mg (BENADRYL) (25 mg Intravenous Given 2/10/21 1137) famotidine 20 mg injection (20 mg Intravenous Given 2/10/21 1138)  Transported to ED by EMS. Symptoms seem comsistent with allergis reaction including itching, hives, feeling lightheaded, nausea, and some abdominal cramping. Given Benadryl, Solu-Medrol and Pepcid. Other than mild itching, did not have any return of other symptoms.  Given prescriptions to continue with Claritin, Pepcid and prednisone. ALso given prescription for EpiPen. Did briefly discuss with allergist on call. No additional recommendations at this time. I do recommend that she follow-up with an allergist sometime the next few weeks.  Pt returned to ED later in the evening reporting throat tightness and itching. Normal vitals and no objective signs of anaphylaxis. DC'd to home.