Age: 74.0
Sex: M
Vaccine: FLU4
Symptoms: Injection site pain, Injection site rash, Injection site reaction, Injection site vesicles, Pain in extremity
Clinical narrative: URTICARIA; blisters Narrative:  follow up: 1/10/2020 patient in clinic with c/o rash, blistering, and  pain at flu injection site from flu shot given on 12/01/2020. Patient called and  states that he has a rash with red bumps and some blisters about as large as a dollar bill. Not having a hard time lifting arm, declares the pain is 7/10 achy pain. Flu shot given on 12/1/20 and he states this started o 12/3/20 with itching and has progressed to this. Has been putting Hydro-cortisone cream on and it has not been helping him. Patient states that about 2 days after he received the flu shot he started getting blisters and open skin areas on the area where he was given the  flu shot. States arm is painful. Was using neosporin but states that did not help.  Also states that he was using the eclobetasol cream on his rash on his legs and  states it has not helped. Patient feels like he needs an abx for this to heel. States the rash and blisters on his left deltoid only showed up after he got the flue shot.  follow up: 1/7/2021 a 73 y/o MALE walked-in this morning with c/o persistant rash. Chart reviewed; Patient last seen face-to-face at PCP appt 12/1/20, rash discussed and evaluated at that time. Per PCP Note, "rash to both lower legs x 2-3 weeks. papular, pruritis above ankle, scaly patch ant L ankle rash on both LE ., L>R . no known bites/stings or exposure," Rash appears very similar at today's visit. Patient states rash is present to BLE. Patient recently finished a Prednisone dose Pack for c/o rash/redness to swelling to arm after receiving the Flu Vaccine. Patient states this did help his BLE rash as well. ASSESSMENT: No redness, swelling or warmth noted to the legs. No drainage or bleeding noted.  No blisters noted. Skin blanches, and pedal pluses present and equal bilaterally.  Patient has scaly, dry skin noted to lower extremities, and small (pin-point) area of open skin. It appears as if patient has been scratching at his legs. Patient  admits to rubbing his legs. Patient states his legs itch, and burn. Patient c/o pain in the legs. Patient ambulated in a clinic today without assistive devices. Gait is normal and steady. No limping, guarding or grimicing noted. RN CONSULT with PCP. Topical Ketoconazole Cream ordered, and Miconazole RX renewal  requested. Patient advised to use topical cream BID for comfort/relief. Patient advised he may also get Aveeno Oatmeal Based Lotion, or Eucerin Lotion OTC for relief of Dry Skin and Itching. Patient advised to apply topical RX cream to clean dry legs, and use OTC lotion intermittently for additional comfort/relief.  Provider: Reason for contact : Recalcitrant LE rash He reports frustration with rash, persists despite PC measures. Discussed Dermatology recomendations with him in detail. chronicity,incurable but treatable Strategies to avoid dry skin Educated on use of Moisturizers - issue Hydrocerin Clobetasol oint x2wks then Tacrolimus 0.1% oint prn if rash persists or recurs keep using for up to one week after rash is resolve Avoid chemical irritatns.