Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Anxiety, Throat tightness
Clinical narrative: Subjective Patient is a 74 y.o. female who was seen at Vaccine Clinic today for her first  dose of the COVID 19 vaccination.    She was given the Pfizer vaccination in the left deltoid muscle.   During her 15 minute waiting period after the injection, the patient began to experience throat tightness.  She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, hoarseness, itching, lightheadedness, dizziness, facial swelling, lip swelling and tongue swelling.   This provider was notified of patient reaction and she was then assessed in the emergency bay area.   Monitored patient for severe reaction symptoms, including but not limited to abdominal pain, blood pressure abnormality , chest pain, collapse, drooling, hypotension, increased swelling, rapid progression of symptoms, respiratory distress, skin changes, tongue swelling and vomiting.   Pt with hx of htn/a-fib, allergies and asthma. She has taken her allergy medications today along with her htn med.  She reports she usually checks her home bp and runs around 140s systolic.  She states her bp is up today as she is anxious.      ALLERGY REVIEW OF SYSTEMS:  Patient denies chills, fever, malaise/fatigue, facial swelling, sore throat, frequent throat clearing, cough, chest tightness, shortness of breath, wheezing, rash, hives, itching of skin, dizziness and headaches    Negative for drooling:  No vision changes:     Previous Reactions: denies prior reactions.     Objective    Vitals Vitals:   02/09/21 1153 02/09/21 1156 02/09/21 1159 02/09/21 1200 BP: (!) 154/138   (!) 219/73 (!) 203/71 BP Location:     Right arm Left arm Pulse: 74 73 72 70 SpO2: 100% 99% 98% 98%          Physical Exam Vitals signs and nursing note reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance.  HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds. No murmur.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing or rales.  Chest:     Chest wall: No tenderness.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm.     Coloration: Skin is not pale.  Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time.     Gait: Gait normal.  Psychiatric:        Mood and Affect: Mood normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.         Assessment/Plan  Treatment included: antihistamines Follow up response to treatment: fair. Patient discharge: Stable to go home and follow up with PCP.  Differential Diagnosis: Vaccine-Related Anxiety (include misc mental health) and Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns)   HTN: pt reports she will monitor at home. She states that she gets like this prior to doctor appointments or visits. She feels well and wishes to go home.  Discussed reasons to follow up with pcp, monitor bp at home. Follow up in ED if throat symptoms worsens or do not improve.    Pt offered wc out to front door. Pt with husband.