Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Urine leukocyte esterase positive, White blood cell count normal, White blood cells urine positive
Clinical narrative: 4/10 - vaccine administered  4/12 - Per patient, "I started the amlodipine and my legs and feet got so swollen and painful." changed from amlodipine to hydrochlorothiazide  4/13: Per patient, "Hi, I had my covid vaccine on 4/10/21  I had the Johnson & Johnson (Janssen) Lot# 201A21A Exp date: 6/23/21. If it could be added to my immunization list. Also I had terrible side effects including high fever which finally subsided yesterday, however my stomach feels like it is being twisted in knots. I'm having terrible cramping pains since Saturday and continues. I have been taking Motrin and Tylenol since Saturday for fever but the stomach pains are unbearable.  4/13 - Presented to ER:     37-year-old female presents emergency department for complaints of right lower leg pain and severe abdominal pain.  Reported the patient had her Johnson & Johnson vaccine on Saturday a.m. several hours afterwards developed severe abdominal pain and tenderness with nausea.  Denies any other specific reason for why this would have occurred.  The patient states that the pain has been increasing since its onset and she is try to tough it at home taking Tylenol.  Patient denies difficulty moving her bowel or bladder.  Patient states in addition to this she developed right lower calf pain and tenderness and is concerned about a DVT.  Patient denies any history of DVT.  Patient otherwise denies any chest pain or shortness of breath.  The patient relates that she has had a fever that was noted on Saturday as well and believes it was just sensitivity to the vaccine.  She states she last noted the fever yesterday with T-max of 101.  Review of Systems  Constitutional: Positive for fatigue and fever.  Respiratory: Negative for cough and shortness of breath.   Gastrointestinal: Positive for abdominal pain and nausea. Negative for constipation and diarrhea.  Genitourinary: Negative for difficulty urinating, flank pain and frequency.  Psychiatric/Behavioral: The patient is nervous/anxious.   All other systems reviewed and are negative.  Physical Exam BP 132/82 | Pulse 86 | Temp (Src) 97.9 (Oral) | Resp 18 | Ht 5' 7" (1.70m) | Wt 210 lb (95.3kg) | SpO2 100% | LMP 01/25/2021 | BMI 32.88 kg/(m^2).  O2 Therapy: Room Air     Physical Exam Vitals and nursing note reviewed.  Constitutional:      Appearance: Normal appearance.  HENT:     Head: Normocephalic and atraumatic.  Eyes:     General: No scleral icterus.    Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Abdominal:     General: There is no distension.     Palpations: There is no mass.     Tenderness: There is abdominal tenderness. There is no guarding or rebound.     Hernia: No hernia is present.  Musculoskeletal:        General: Tenderness present.     Right lower leg: No edema.     Left lower leg: No edema.     Comments: Right calf pain  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.  Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time. Mental status is at baseline.  Psychiatric:        Mood and Affect: Mood normal.        Thought Content: Thought content normal.