Age: 14.0
Sex: M
Vaccine: COVID19
Symptoms: Anxiety, Dehydration, Dizziness, Feeling cold, Heart rate abnormal
Clinical narrative: Patient is a 14 YO male with no previous medical history that received the Pfizer vaccine administered into his left Deltoid at 1406. He was sent to the observation area where the nurse noted him looking pale at 1410. His mother was present during this whole event. He was taken over to the medical tent for privacy and further evaluation. He was complaining of being light headed. He was given apple juice and crackers as he had stated that he had not eaten or drank anything all day.    At 1430 his VS read BP 132/80, HR 145, O2 99%. At this time he was lying down and feet elevated, shaking, pale, and cold. Lung sounds clear. Nausea but not needing to throw up he was covered up to try and keep him warm. At 1440 his blood pressure was 130/82, HR 130, 02 98% At this time he was lying flat with feet elevated, shaking, pale, and cold. His lung sounds clear.  Nausea, but not needing to throw up.  At 1450 BP 138/74, HR 120-135, 02 98%. Symptoms had not changed at this point except he mentioned his ears felt cold, although they were warm to touch.  He was laid on his left side at this point to try and lower his HR, which did come down to 115-125 when on his L side. We did not take a BP at this point as we wanted him to be on his back when taking them.  At 1515 he was laid back on his back to see how his HR would do and how his BP was. BP 138/60, HR 135, 02 98%. Again symptoms were the same except he was complaining of colors being more ?dull?, and his teeth being numb. At this point his pupils were noted to be +8, equal and reactive.  1521 VS read 138/50, HR 135, 02 98%. Vision still dull and pupils unchanged from 1515. He was laid on his R side to see if this would lower his HR. It was brought down to 120-130 on his R side. We gave him a cookie to snack on to see if that would help with any of the paleness, shakiness, and light headiness. He was able to take a few small bites.  Hands pale and washed, with +1 bilateral radial pulses.  1529 he was sat up slowly to try to get him to hydrate, as it was apparent he needed fluids onboard. His BP read 142/80, HR 124, 02 98%. He was still complaining of lightheadedness. After sitting up and drinking half a bottle of water and some cookie, he stated that colors were becoming more vibrant. He noticed my eyes were very blue, which previously he had stated they were grey. He stated his lightheadedness had improved and that he was feeling better. We had him sit up for a while and his color started to come back, although his L arm was still pale, of note this was the Vaccinated arm.  At 1546 his VS read 150/82, HR 117, O2 99% while sitting. His only complaint was feeling like the air he was breathing ?was cold?.    At 1607 he was stood up and when doing so his HR went to 140. After standing for about 4 minutes his BP read 120/82, HR 114, O2 98%. His pupils +6 , equal, round, and reactive.  He was feeling way better and his color in his L hand was back equal to his right. He was slowly walked around a chair just to see how he would do with activity. His HR was anywhere from 94-120 when walking around the chair, he complained of no dizziness, or other symptoms.  At this point he had finished 2 apple juices, crackers, a cookie, and a bottle of water for a total of 1.5 L of fluid.  He was sat back down in the chair to rest and see how things went for a while. His HR was anywhere from 109-120 when in the chair, although he did appear very anxious through this whole process. When he was given a task it appeared that his HR was a few points lower.   His final HR was 109, BP 130/82, O2 98%.  Of note he did complain of his feet and fingers feeling tingly a few times during this process. Sometimes his feet would be tingly when elevated and then when the garbage can holding them up was readjusted it resolved. These were intermittent complaints.  At this point it is 1630. He has responded to fluids and is stable to go home with his mom. It was recommended for him to increase his fluids tonight, and to eat something. He was sent with a bottle of water. It was also recommended to get a pulse ox machine from a pharmacy so that his HR could be monitored and if it does not come down under 100 by tomorrow to make an appointment with his MD to follow up.  If any of these symptoms were to come back or if his mom had any concern at all it was recommended to take him to the ED for observation. It was also recommended to follow up with his primary even though he left stable.  Throughout this process, I considered administering Epinephrine. The problem was his BP was not low and we could not get his HR to come down. I did not want to increase his HR any more than it already was unless I was absolutely necessary. Given that he responded to fluids, it was decided not to administer it.   Given that it took him 2.5 hours to recover from this vaccine, I strongly recommend that he does not get his second dose. I consider this to be an adverse reaction, and his mom was in agreement.