Age: 52.0
Sex: F
Vaccine: COVID19-2
Symptoms: Anaphylactic reaction, Breath sounds abnormal, Dyspnoea, Dyspnoea exertional, Feeling cold
Clinical narrative: Patient presented for Moderna Bivalent Booster at mobile vaccination clinic. Patient was registered, injected, and placed into observation per SOP. Patient did report an allergy to eggs, so patient was cleared for vaccination with observation of 30 minutes.  Approximately 10 minutes into observation period, patient approached Lead RN and asked "Is it normal to feel cold in my throat?". Lead RN & Auxiliary RN began assessments. No obstruction was visualized in airway. Patient continued to feel sensation of cold and and additionally some tightness in throat. Lead RN activated BLS protocol. Lead RN attempted to obtain BP using manual cuff & stethoscope supplied in anaphylaxis kit. However, BP was not auscultatable. Auxiliary RN then attempted and also could not auscultate. Auxiliary RN asked Team LVN to obtain a wrist cuff from the facility. Initial were hypertensive & tachypneic. Additionally, Auxiliary RN was auscultating lungs and assessed diminished upper lobes with anterior/posterior wheezing sounds. Auxiliary RN recommended to Lead RN that assessments are consistent with anaphylactic reaction and that epinephrine should be administered. Lead RN then immediately administered epinephrine 0.3mg via autoinjector to right thigh. Concurrently, one Team LVN was on telephone with Duty Officer and another Team LVN called 911 for EMS. After administration of epinephrine, patient continued to be AOX4, continued to have sensation of difficult breathing, and cold extremities. RNs taught patient to deep breathe and perform vagal maneuver on self.  EMS arrived approximately 15 minutes later at approximately 11:00. Lead RN gave report to Paramedics. Paramedic commented that pulse ox showed "low SPO2". During Paramedic interview, patient newly disclosed that she has Hx of asthma and uses an inhaler but does not have it with her. Crucially, staff member reveals at this point that patient ate eggs in the morning and continues to enjoy eggs despite her allergy. Paramedic instructed patient to walk to the gurney, but patient stated "I don't think I can". On 2nd request, patient walks to gurney.  Paramedic told Lead RN that patient will be taken to Hospital.  VS: 1040: BP 151/99 & HR 94 & RR 26 & Capillary Refill Greater 3 Seconds. 1046: BP 112/66 & HR 61 & RR 22 & Capillary Refill Under 3 Seconds (epinephrine had been administered) 1051: BP 173/145 & HR 109 & RR 25 & Capillary Refill Greater 3 Seconds.  NAx: 1040: Lung sounds upper lobes diminished. Lungs sounds anterior/posterior wheezing. Patient outwardly nervous but otherwise AOX4 and compliant with instructions to perform vagal maneuvers on self. 1051: Lungs sounds wheezing improved but continues. Patient reports continued sensation of breathing difficulty. Extremities cool to touch. Patient outwardly nervous but otherwise AOX4 and compliant with instructions to perform vagal maneuvers on self.  I called patient's cellphone the day after on 01/13/2023. She answered and stated that she was still at hospital. She sounded lethargic but fully conversational and AOX4. She stated that she still has SOB when walking to the bathroom.