Age: 38.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Nausea, Pain
Clinical narrative: Patient states that she received the vaccination at 10:24 AM.  Patient states approximately 2 minutes after that she felt pain and swelling and erythema in her left arm at the injection site.  Patient states she felt like she had a somewhat of a "apple in her throat".  Patient states that her left arm was tingly.  Patient states that she has a headache in the bitemporal area.  She states that she has a history of headaches.  Patient states that she has no visual changes.  Patient states that it started after the immunization.  Patient states 5 minutes before I came into the room she vomited and now feels tremendously better.  She is talking in a complete sentences.  Patient is somewhat tachycardic on initial Patient states that she received the vaccination at 10:24 AM.  Patient states approximately 2 minutes after that she felt pain and swelling and erythema in her left arm at the injection site.  Patient states she felt like she had a somewhat of a "apple in her throat".  Patient states that her left arm was tingly.  Patient states that she has a headache in the bitemporal area.  She states that she has a history of headaches.  Patient states that she has no visual changes.  Patient states that it started after the immunization.  Patient states 5 minutes before I came into the room she vomited and now feels tremendously better.  She is talking in a complete sentences.  Patient is somewhat tachycardic on initial presentation.  Patient presents via BR RT for evaluation.  Patient has a host of allergies.Patient is anxious upon presentation.  Patient does have a history of anxiety.  No other travel or trauma.  Patient states that her pain is severe.  States that she has some pressure in the bitemporal portion of her head and her left arm injection site.  Otherwise nonradiating.  No other known aggravating, triggering or alleviating factors.  Patient dates its concurrent with the injection time.  Otherwise nonradiating. BP 180/100 at 1045, O2 sat 98%, ECG sinus tachycardia Repeat Vital Signs BP 133/82  | Pulse 82  | Temp 36.9 °C (98.4 °F) (Oral)  | Resp 16  | Ht 1.702 m (5' 7")  | Wt 197 lb 1.5 oz (89.4 kg)  | SpO2 98%  | BMI 30.87 kg/m²  Constitutional:  Well developed; well nourished; in no apparent distress; non-toxic appearance HEAD: Atraumatic.  Normocephalic. Eyes:  PERRL; EOM intact; conjunctiva and sclera normal to inspection. HENT: TM's normal; no rhinorrhea; normal pharynx with no erythema or exudates.  Mucous membranes are moist.  Uvula is midline.  No hemotympanum or foreign body. NECK: Supple; non-tender; no cervical lymphadenopathy. Respiratory:  No respiratory distress; normal breath sounds; breathing non-labored Cardiovascular:  Normal rate; good peripheral perfusion. No murmurs or rubs CHEST: Nontender.  There are no retractions. GI:  Normal bowel sounds; non-distended; non-tender to palpation; no palpable organomegaly GU: Musculoskeletal:  Extremities non-tender; normal range of motion; no edema; Normal distal pulses Back -Normal tone; no tenderness Integument:  Well hydrated; no lesions; no significant rash or palpable nodes. Neurologic: Alert, appropriate; oriented to person; place and time.  No focal deficits.  Motor 5/5.  Sensation intact in all 4 extremities. Psych:   Mood and affect are anxious.  Mental status appears normal at time of exam. Patient upon presentation is anxious.  Patient did vomit x1.  Patient was talking in complete sentences upon my evaluation.  Patient feels that she has some discomfort to her injection site with a headache.  They feel no warmth or erythema.  Patient was given Tylenol for the headache which did improve.  Also received ondansetron, diphenhydramine, famotidine, methylprednisolone, NS 1000mL. Patient was monitored for an extended period of time and has had no return of symptoms.  I am uncertain whether this is a true allergic reaction since the symptoms started approximately 2 minutes from the time of the injection.  Patient does have a history of anxiety and this may have played a role within the symptomatology.  At this time patient feels much better.  Patient be dismissed we will send the patient home with a prednisone taper.  She can take oral Benadryl and Pepcid.  Follow-up with her family doctor next couple days not feeling better.  Patient is dismissed. Patient returned to ED on 10/22/20 0100. Presents to ED complaining of numbness and tingling all the way from her head to her left toe on the left side. Has taken Benadryl 3 times today. She states that she woke up this evening with her heart racing.  She still has a little bit of a headache.  No fevers.  He was nauseous.  Again she says the whole left side of her body is tingling. All  other systems negative/without deficit. HR 124, BP 168/107. Repeat Vital Signs: BP 129/77  | Pulse 99  | Temp 37.2 °C (98.9 °F) (Temporal)  | Resp 20  | Wt 206 lb 2.1 oz (93.5 kg)  | SpO2 100%  | BMI 32.28 kg/m²  EKG showed a sinus rhythm without acute ST changes.  She is anemic but she has a history of that and her hemoglobin is not significantly lower than usual.  Sed rate is little bit elevated but her C-reactive protein is normal.  Her glucose slightly elevated at 173 but the rest of her labs are normal.  CT and CTA of her head and neck were normal.  I do not know at this time if this is a reaction we will have her continue the prednisone taper she was started on earlier as well as Benadryl and have her follow-up with her primary care physician.