Age: 14.0
Sex: F
Vaccine: HPV9
Symptoms: Neurological examination normal, Pallor, Protein total increased, Pruritus, Rash
Clinical narrative: "Chief Complaint Patient presents with *Shortness of Breath  Patient had HPV vaccine around 1400 today. Patient is a 14-year-old female with no significant past medical history who presents With her mother and fatherto the ER with a chief complaint of a rash. She reports that she received the first dose of the HPV vaccination earlier this afternoon around 2PM. She noticed at 9 PM after running some errands that she had a rash throughout her body. She reports that the rash is itchy and somewhat painful in some places. She also reports having a scratchy throat for which she took 1 Benadryl and those symptoms resolved. Pt was at the lake yesterday as well. She denies any present shortness of breath or throat discomfort. She denies any nausea, vomiting, or diarrhea. She and her mother deny any history of vaccine reactions or chronic medical conditions, including any allergies". Progress notes  After being placed in a room, the patient was thoroughly interviewed and evaluated. Nursing notes were reviewed. All ordered imaging was reviewed. A wide differential diagnosis was considered to exclude life and limb threatening emergencies. The pt's symptoms were addressed during the visit and reassessed after interventions. Patient is a 14-year-old female with no significant past medical history who presents with her mother and fatherto the ER with a chief complaint of a rash. She reports that she received the first dose of the HPV vaccination earlier this afternoon around 2 PM. She noticed at 9 PM after running some errands that she had a rash throughout her body. She reports that the rash is itchy and somewhat painful in some places. She also reports having a scratchy throat for which she took 1 Benadryl and those symptoms resolved. Pt was at the lake yesterday as well. She denies any present shortness of breath or throat discomfort. She denies any nausea, vomiting, or diarrhea. She had her mother deny and history of vaccine reactions or other chronic medical conditions, including any allergies. Initial vitals 110/77, temperature 98, pulse 89, respirator rate of 18, O2 sat of 100% on room air. Patient is not in any acute distress. PE reveals no signs of angioedema, lip swelling oropharynx swell, or tongue swelling. Cardiac exam is unremarkable. Pulmonary exam is unremarkable with no wheezing or rhonchi and no stridor. Abdominal exam is unremarkable. Skin exam does not reveal a maculopapular pruritic rash or bilateral lower extremities with minimal excoriations. Blanchable. Neurologic exam is unremarkable Patient was given prednisone 20 mg oral as well as Pepcid 20 mg oral. I did discuss with patient and family with patient that we will observing for any concerning symptoms for 1 hour but at this time patient is stable and asymptomatic other than itchy rash. Patient did have some improvement in the pruritic aspect of the rash but was still having some pain and burning sensation under the rash. I did give the patient 12.5 mg of Benadryl IM injection and applied hydrocortisone cream to patient's rash. At this time patient did have significant improvement. CBC reveals a hemoglobin of 11 otherwise unremarkable. CMP reveals a CO2 of 21 and total proteins of 8.4 otherwise unremarkable. LDH is normal. Patient stable during entire ER stay with no shortness of breath, swelling, angioedema, or signs of anaphylaxis. I did discuss with patient that likely her rashes were due to bites or contact dermatitis from something at the lake but we will be putting her on prednisone 20 mg twice a day for 3 days as well as Benadryl as needed every 8 hours. She will also continue to apply the hot hydrocortisone cream as needed for itching up to 3 times daily. I did discuss wit