Age: 19.0
Sex: M
Vaccine: TDAP
Symptoms: Pain, Physical examination, Pruritus, Swelling of eyelid, Throat tightness
Clinical narrative: Per H&P:  Presenting for evaluation of laceration to the left medial forehead after the patient hit his head on an open car door.  Patient says he was under the car working and when he rolled out from under it the door was open and he went to sit up hitting the side of his head.  Patient states he hit his head so hard he initially saw stars however he denies loss of consciousness, headache, neck pain, nausea or vomiting. Per provider note: Patient's tetanus was updated today as it has been over 10 years since his last vaccination.  patient discharged home.   Per H&P:  Presenting via EMS for evaluation of possible allergic reaction.  Patient states he first felt dizzy and then nauseated and like his throat was closing.  He then experienced cough, chest pain and vomited twice.  EMS gave the patient 125 of Solu-Medrol, 50 of Benadryl, 0.5 epi IM and 2 of mag with improvement of his breathing and chest pains. He is now complaining of his entire body aching.  He denies any drug use prior to the incident.  Patient was seen in the emergency department today for a closed head injury and laceration repair with Dermabond and received a tetanus shot at that time.  Patient thinks that his reaction may be related to that as symptoms onset approximately 1 hour after discharge home. Had a tetanus shot in the past and tolerated it without complications.  Denies syncope, blurred vision, fever or abdominal pain.   In summary, patient is a 19 y.o. male presenting for evaluation by EMS for possible anaphylaxis after receiving tetanus shot in the emergency department earlier today.  Patient states that the resume the shot he had no symptoms and was discharged.  Approximately 1 hour after his discharge he began to experience dizziness, nausea, the sensation that his throat was closing.  Which also developed into cough, chest pain and 2 episodes of emesis.  Patient had pain all over and asked his mom to call 911.  EMS gave Solu-Medrol, Benadryl, epinephrine and mag with improvement of his breathing and chest pains in route.  Patient presents complaining of his entire body aching and some itching on the upper thighs.  Denies syncope, blurred vision, fever abdominal pain.     In the emergency department, the patient's vital signs are stable.  He is in mild distress secondary to diffuse myalgias.  Physical exam shows evidence of anaphylaxis with allergic shiners swelling of the eyelids.  Patient speaking in full sentences, no respiratory distress, lungs are clear to auscultation.  Remainder of exam is benign.  Given that patient was treated in route for anaphylaxis and his symptoms were resolving, plan is to monitor for 4 hours after epi dose for reemergence of his symptoms.  I gave patient 1 dose of Pepcid for itching.  EKG showed sinus bradycardia with no evidence of ischemic changes.  Lab studies were not obtained.  On signout, patient's vital signs are stable and he was resting comfortably.  If patient has no additional symptoms over the monitoring period, he may be discharged home with an EpiPen.  If his symptoms recur, he will be admitted for further monitoring and evaluation.  Patient signed out to Dr.