Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Throat irritation, Throat tightness
Clinical narrative: 35 y.o. year-old female RN that presented to the clinic today for a Pfizer-BioNTech COVID-19  vaccine.  Pfizer-BioNTech COVID-19  vaccine was administered at: Time: 0852 Date: 12/31/2020  Patient presented with symptoms at time 0905 while being observed following vaccine.  Patient's symptoms include the following:  Skin and Mucosal symptoms: No  Respiratory Symptoms: Yes: Sensation of throat closing.  If described on scale of 1-10 with throat closure being a 10, stated "throat closure could feel like a 2-3 on 1-10 scale.  Symptoms also described as "scratchy throat". She hadn't had any breakfast today.    She reported history of reaction after pneumococcal ppsv 23 vaccine which consisted of very red, sore, swollen arm with fever following vaccine.  Reported to healthcare provider who let her know she "suffered an allergic reaction to one or more components of the pneumococcal vaccine and not just side effects".  She was treated with ibuprofen, ice, and advised to take zyrtec, allegra, or benadryl.  She reports she took benadryl and never required any epinephrine.  She denied any shortness of breath, difficulty breathing, or swelling of the face, mouth, or throat with that reaction.    She does report a possible reaction to bees/wasps for which she felt previous tingling in the lips, but when reviewed with her PCP, they opted to not order epi pen for her use at the time.  She denies ever needing epinephrine or epi pen use in the past that she is aware of.   Gastrointestinal Symptoms: No  Cardiovascular: Yes: Dizziness  The following actions were performed: Patient was brought to exam room to lie down Feet were elevated Given some water  Given some juice Vital signs: @0915 BP 130/85, Pulse 84, Oxygen on room air 100%, Temp 98.8 F, @0923 BP 126/85, Pulse 75, Oxygen on room air 100%  Airway, Breathing, Circulation, and level of consciousness assessed and normal Bendaryl 50mg administered as a single dose   Patient reported dizziness was resolved quickly after lying down.  She stated her "throat closure" symptoms were also improved.  She drank water, apple juice, and had 2 saltine crackers without incident.    Airway, Breathing, Circulation normal throughout assessment period.  Vital signs again checked at 0945:  BP 135/85, Pulse 80, Oxygen 100%, Temp. 98.9 F.  Discussed normal adverse events following this vaccine with patient.  Also discussed more severe adverse events which can include difficulty breathing, swelling of face/throat, fast heartbeat, bad rash all over body, and dizziness or weakness.  Discussed she could take another dose of benadryl if she was concerned about any continued, mild swelling of throat in 4-6 hours.   If she has severe swelling of face/throat that is worsening or not resolved with benadryl, she should call 9-1-1 immediately.  She voiced understanding.  We discussed that she would need to weigh the benefits/risks of a 2nd dose, and if she does choose to get a 2nd dose based on a minor reaction not causing severe anaphylaxis, she would need to make sure staff are prepared with benadryl and epinephrine to be used if needed.  She voiced understanding.  Her husband was notified and he came and picked her up after she was observed for an additional 30 minutes in the observation area outside the clinic.  She left the observation area at 1016.