Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Heart rate increased, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash
Clinical narrative: 31JAN2021: -Received her first shot of Moderna vaccine in right deltoid with subsequent 24h sore right shoulder but zero other symptoms  25FEB2021: -Received her 2nd shot of Moderna vaccine in left deltoid. No acute symptoms.   26FEB2021: -Noticed diffuse joint pain throughout ALL joints, exhaustion, severe headaches, nausea  -Took Advil at night for these symptoms and felt better for several hours before resurgence of symptoms  27FEB2021: -Slept all day and then felt completely better, good appetite, watched her daughter?s volleyball tournament  -That night, noted a red circle (non-raised, not itchy) at the site of the left deltoid injection  28FEB2021: -Red circle had increased in size to the size of a quarter but she felt fine otherwise -By the night time, the left deltoid had swollen to softball size and became itchy   01MAR2021: -Increased size of left deltoid swelling and persistent itching, went to see PCM and got topical hydrocortisone and Benadryl   Over the first week of March, her daughter (who rooms with parents but downstairs) developed COVID-19 and was isolated as best as possible away from mother for 10 days. The patient noted that the arm just kept getting worse (continued progression of swelling with small itchy bumps that popped and oozed fluid, developed pain in left elbow with severe swelling. Lesions were painful to touch). Was visiting with her PCM every Monday and saw her multiple times who gave her an ?antibiotic cream? which the patient reports she could not use because it was too large of an area. On 12MAR, she was given more Benadryl, an EpiPen, prednisone taper (starting at 60mg per day), and Keflex which the patient started taking. Her PCM said if she did not get better in 24h to go to the ED.   13MAR2021: The patient came to the ED and was assessed and released with Atarax and doxycycline and she continued the prednisone given by her PCM. She had taken two doses of doxycycline and three doses of Atarax before heading to the ED once again on 15MAR2021.   15MAR2021: Came to the ED again after noticing at work that her face was red and her tongue was swelling in the back of the throat. She was driven to the ED by her husband. She was given an EpiPen in the ED quickly. Her heart rate became fast, she reported, but the EpiPen resolved her itching of the face/neck, the redness dissipated, and her tongue felt ?back to normal.? She also received Solumedrol 125mg IV, Benadryl 25mg IV, and 1L normal saline. Several hours later, her tongue swelling and face itching and red rash returned, and she received an additional EpiPen IM injection and then Valium 5mg PO which resolved her symptoms and helped calm her down. She was then admitted for 2 nights in the step down for observation. She reports this was an unremarkable admission and she felt fine after the second EpiPen injection. The only symptom she reported was a bad headache the whole admission which was not relieved well with ibuprofen and acetaminophen. She said she had some peeling of skin on her left arm as well.   17MAR2021: Discharged home, headache persisted. Rash on face/neck and tongue swelling was completely gone. The swelling and lesions and pain on the left upper arm had improved but pain and swelling in the left arm were still present. She took a steroid taper for a week along with Pepcid and Benadryl daily.   From 17MAR2021 until today 20APR2021, her left arm swelling has slowly improved. She saw her PCM twice in this timeframe. The first time, she gave pt. 15 days of 10mg prednisone PO daily and Pepcid and Benadryl because her left arm swelling had resurged. This regimen helped reduce the symptoms. The second time she went to see her, she increased her Benadryl to 50mg PO nightly to reduce itching of the left arm and was given another 9 days of 5mg PO daily prednisone which she finished 20ARP2021. The additional prednisone was given because the patient had reported a resurgence of the symptoms of itching and swelling of the left arm.   The itching and the swelling of the left arm completely resolved by 07APR and she went back to her job on 13APR.