Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Somnolence, Tongue discomfort
Clinical narrative: Pt noted after approx 15 minutes a tingling/burning sensation of tongue At 4:45 pm.   No associated SOB, facial swelling.  She does have prior anaphylaxis reaction to pineapples for which she carries and epi Pen but has never needed to use.   Cardiac exam RRR Lungs CTA bilat HEENT, no visible erythema of face or tongue and no noteable facial swelling  She was agreeable to 25 mg dose of diphenhydramine and another 15 minute observation.    During this time, she began to feel anxious and a mild headache.  Vitals at that time were notable for bp 178/81, HR 101 and o2 sat 98%.  Still no SOB, facial swelling or other new complaint.  She felt improvement in anxiety within 5 minutes, and repeat vitals in 10 min with BP 152/83, HR 89 and O2 sats 96%  She still continued with mild sensation change of tongue, but no facial swelling.   She does have benedryl at home but I also sent her home with additional 25 mg dose in case she noted recurrent symptoms on the way home .  She understands to seek emergency care with any worsening symptoms, or new SOB or facial swelling. She can also use her EPI pen if needed.  She felt comfortable returning home- husband picked her up.    I will call her to check in this evening and in the morning and will provide updated recommendations regarding second dose of vaccination.     I spoke with patient at 8:09 pm - she was at home- feeling much better, however, she did take the second diphenhydramine on the way home, as she began to feel she was having some swelling between her eyes.  No SOB  Or trouble swallowing.  This improved with the second benedryl and has not recurred.    She will take an additional 50 mg benedryl before bed, and then she awakes before 6 am- if she has any residual symptoms she will take another dose.  Again, she understands to seek emergency care with any worsening symptoms, or new SOB or facial swelling. She can also use her EPI pen if needed.  She felt comfortable with this plan.    We also reviewed current CDC guidelines and she understands at this time we would not recommend she receive the second Vaccination.  She will continue to follow CDC in the event that this recommendation changes.  I will submit a VAERS report after following up with her in the morning.     ADDENDUM 2/3/21:  I spoke with patient again on 2/3/21 at 07:45 am. She is feeling almost completely back to baseline this morning, but planning to take 25 mg diphenhydramine this morning as well. She does note mild headache, which is not abnormal for her.  No residual tongue sensitivity or facial swelling.  She noted that when she got home last night, she felt very sleepy and sedated from the diphenhydramine and went to bed, and did not take an additional dose of diphenhydramine last night.  No SOB, trouble swallowing or any new complaint.  No urticaria or itching.    We reviewed current CDC recommendations to decline second vaccination given her moderate severe allergic symptoms within first 4 hours of first vaccination.  She will follow up with PCP or kidney specialist if she has any continued concern with ongoing symptoms or new issues.  She was very appreciative of the followup and care provided.