Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Feeling hot, Pruritus
Clinical narrative: 0900: While sitting in observation area, pt began c/o bilateral anticubital itching "10 mins" post 1st Pfizer (Lot # FF 2593) vaccine that "wasn't getting any better". Pt reports that she has an extensive history of allergies to medications, alongside a history of anaphylaxis where her "throat closed up and they needed to give me lots of medications". She indicated that she did not have her Epipen on hand and "I have not needed to use it for quite some time now". Pt ambulated to AR monitoring area with steady gait and placed on monitors. She denies any SOB, dizziness, chest pain or palpitations. Upon physical exam, there is no redness or rash noted to bilateral arms however pt does indicate that the "itching" is progressing to "itching behind my thighs and I feel hot", 6/10 scale. No facial swelling or circumoral/tongue swelling, pt is speaking full and very clear sentences, RR even and unlabored. -stridor or wheezing. Pt indicated that with her above symptoms, she does not feel that she currently needs her Epipen and she is "comfortable". Pt provided comfort measures- rest and ice packs to bilateral arms for itching and will continue to monitor very closely. She indicates that this morning she took all her prescribed medications as directed however "my blood pressure does run very high". Vital signs as charted below and pt indicated "my blood pressure is usually much higher than that". She also indicates that today her mode of transportation was a rideshare to the Covid Vaccine Clinic and she would be utilizing the same transportation method back home. Contact being made with on call ED MD due to pt's strong history of allergies and anaphylaxis.   T 98.7 BP 191/111 HR 112 RR 24 SPO2 98 on Room Air  0915: Contact was made with ER MD and verbal orders obtained for AR RN to give now- oral Benadryl 50 mg po and Ceterizine 10 mg po. Pt remains with the above symptoms but also remains speaking full and clear sentences, confirming that she is still able to swallow her own saliva comfortably. She denied any swelling or closing of her throat and tolerated very well water with both medications. Rechecked vital signs and as charted below. Continue to monitor closely.   BP 160/95 HR 99 RR 22 SPO2 99 on Room Air  0930: Pt reports that since being medicated above, her itching and "feeling hot" has "gotten much better" and decreased from a 6/10 to now a 3/10. Pt resting quietly and no longer seen itching her bilateral arms. She continues to speak in full and clear sentences and remains free of stridor/wheezing. She continues to tolerate water at bedside. Vital signs as charted below. Will continue to monitor very closely.   BP 164/98 HR 96 RR 20 SPO2 100 on Room Air  0945: Pt reports complete resolution of itching to bilateral arms and thighs, alongside "feeling hot". She denies any discomfort or distress and continues to speak in full, clear sentences. RR remain even and unlabored and she also remains -stridor/wheezing. Road tested and pt ambulated with very steady gait. -chest pain/palpitations/dizziness. Dr. updated with pt condition. VIS and post vaccination/ Pfizer educational tools provided and reviewed with pt who verbalizes understanding. Advised pt to seek medical attention in the ED should her symptoms not improve, changes, worsens or becomes life threatening. Also advised for pt to follow up with her PCP regarding today's symptoms and her scheduled 2nd dose for 11/22/21 at 8am. Pt verbalizes understanding of all instructions. Pt is arranging her transportation home.   BP 164/93 HR 94 RR 20 SPO2 99 on Room Air  0953: Transportation arrived for pt and she ambulated with very steady gait out of Covid Vaccine Clinic without any incident.