Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Paraesthesia, Rash erythematous, Skin warm
Clinical narrative: Subjective Patient is a 36 y.o. female who was seen today for her first  dose of the COVID 19 vaccination.    She was given the Pfizer vaccination in the left deltoid muscle.   During her 15 minute waiting period after the injection, the patient began to experience warmth of left arm and chest. Red rash present on left forearm. Later she developed tingling of left arm.  She denied difficulty breathing, difficulty swallowing, lightheadedness and dizziness.   This provider was notified of patient reaction and she was then assessed in the emergency bay area.   Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality , rapid progression of symptoms, respiratory distress and skin changes.     ALLERGY REVIEW OF SYSTEMS:  Patient denies chills, fever, facial swelling, chest tightness, shortness of breath, wheezing, dizziness and headaches    Warmth of left arm with tingling:     Previous Reactions: Flu shot made her really sick in the past with respiratory issues. She has had a tetanus shot in the last 3 years though and she handled it well without any symptoms.     Objective    Vitals Vitals:   03/05/21 1202 03/05/21 1238 03/05/21 1305 BP: (!) 139/100 (!) 134/112 126/86 Pulse: 80   92 SpO2: 99%   99%      Physical Exam Constitutional:      Appearance: Normal appearance.  HENT:     Head: Normocephalic and atraumatic.     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear. No posterior oropharyngeal erythema.     Comments: No swelling or lips or tongue.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses:          Radial pulses are 2+ on the right side and 2+ on the left side.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing or rales.  Musculoskeletal:     Comments: Equal hand grip in bilateral arms. No weakness noted.   Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.     Findings: Rash (lower arm and near injection site) present. No erythema.  Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time.        Assessment/Plan  Treatment included: antihistamines, water and pepcid and Tylenol. Applied ice to left arm near injection site where warmth was noted. Redness of lower and upper arm resolved with time. Follow up response to treatment: good. Symptoms resolved upon discharge and BP improved. She still had some warmth of right arm after being observed for 1.5 hours. She did not have any rashes, swelling, burning or weakness of left arm. Discussed with patient continuing to ice left arm near injection site. If she experiences any redness, swelling, burning or worsening symptoms this weekend she is to seek medical care. Pt understands and agreed to plan.  Patient discharge: Stable to go home and follow up with PCP.  Differential Diagnosis: Local reaction (arm pain, bleeding/bruising, mechanical irritation, localized rash)  3/5/2021 1:05 PM