Age: 55.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Injection site erythema, Injection site paraesthesia, Injection site pruritus, Injection site urticaria, Limb discomfort
Clinical narrative: Patient felt she had warmth at site of injection,89 HR 81.  Patient says normal BP 120's/80's.  Patient states she is not anxious.  She then started feeling like her throat and chest were getting itchy.  Continued monitoring and she felt she needed to be evaluated in ER.  Taken to ER.  ED notes as follows: 55 y.o. female who arrived by to the emergency department for Throat and chest discomfort associated with voice change and pruritic rash.  Past medical history of food and environmental allergies, Addison's disease, thyroid disease, primary immune deficiency disorder.  Half an hour ago, the patient received her first injection the Covid vaccine.  Seconds later, the patient started having a pruriti rash where the site of the injection was.  She then noticed her chest getting red and warm.  About 15 minutes later, the patient noticed her voice becoming hoarse her and associated with throat and chest discomfort.  Reports that she is unable to take a deep breath.  Denies any noisy breathing, nausea, vomiting, abdominal pain, shortness of breath, difficulty swallowing, drooling. She has never been hospitalized for anaphylaxis.  She denies any past medical history of asthma or COPD  Vital signs demonstrate hypertension with systolic blood pressures into the 180-190s. No oropharyngeal swelling.  Hoarse voice. Scleral injection present bilaterally. Chest wall nontender.  Mild, blanching, erythematous, pruritic rash on anterior chest. Shallow breathing when asked to take a deep breath. Injection site covered with bandaid with no other obvious rashes or swelling  patient arrived to the ED in no acute distress and in stable condition. She was complaining of throat discomfort with voice changes. She has never had an anaphylaxis reaction before. She was given benadryl, famotidine, and methylprednisolone initially for her reaction. With her hypertension and reported chest discomfort, epinephrine was not given initially.   Her symptoms mildly improved with the initial treatment.   Patient complained of chest discomfort and EKG showing T wave inverted in leads V4-5. She was given aspirin. Initial troponin negative and repeat was ordered.   After four hours of observation, the patient reports her voice change has resolved but continued to have pruritis in different, migrating areas of the body such as ears, neck, and arms.    1330: patient complaining of increasing chest and abdominal pain. Described as a cramping chest pain that radiated to her abdominal. Denies nausea, vomiting or diaphoresis. Continues to deny shortness of breath. Given morphine for her pain and aspirin for her nonspecific EKG changes.   Internal Medicine consulted for admission due to allergic reaction. Patient is agreeable to this plan. Patient was transferred under stable condition to the IM service.   Initial Vital Signs [02/03/21 1159] Blood Pressure 168/101 Heart Rate 73 Respiratory Rate 15 Temp 36.8 °C (98.3 °F) Temp src Oral SpO2 96 %  Following one day admission she was discharged to home with Zio patch monitoring while on new beta-blocker therapy for symptomatic PVCs with plan for PCP follow-up. Regarding adverse drug reaction, she was advised to follow-up with PCP and immunologist for further discussion on benefits:risk of subsequent vaccine in series.