Age: 29.0
Sex: F
Vaccine: RAB
Symptoms: Throat irritation, Tremor, Vision blurred
Clinical narrative: Pt presents to immunization clinic today to start Rabies PreP as she is beginning work at the animal shelter and will have higher risk of exposure to rabies. Pt states that she had an "anaphylactic reaction" to the Moderna COVID-19 vaccine in early 2021. She received that vaccine at the student health center. She states that within minutes after receiving that vaccine, she experienced a metallic taste in her mouth and tightening in her throat. At that time, she self-administered her epi-pen. The epi-pen was effective in managing this reaction. Pt states that she did not go to the hospital after this incident and the doctor she saw at the clinic recommended she not get Moderna COVID-19 vaccines again. She is unsure if there is a particular ingredient that she had a reaction to during this incident and did not get any follow-up testing or care.          Pt states she had no issues with childhood vaccines and received a Tdap in the "last few years" and had no issue with it. She states that she is allergic to "sulfites". Later in the appointment, she stated that also has a severe allergy to grapes.          This RN educated the patient on the risk of adverse reaction to rabies vaccine, as well as the risks associated with rabies exposure in her work environment. The patient consented to receiving the rabies vaccine today. Knowing her history of past vaccine reaction, we planned to have her stay in the clinic for 15 minutes after receiving Rabavert.          At 1313, this RN administered the Rabavert vaccine. The patient remained seated for a few minutes and chatted with this nurse. She stated that she had a funny taste in her mouth but otherwise felt fine. At this point, the patient went to sit in the lobby of the clinic.          At 1320, this RN checked on patient in the lobby. The patient stated that she felt like her vision was "fuzzy" and that she didn't feel well. She stated that her breathing felt normal and that she was able to walk. She appeared flushed, but with unlabored respirations. She walked with stand-by assistance back to the exam room.          This RN and another RN had patient lay with her feet elevated and provided apple juice box to the patient. Pt states that she felt very "hot and shaky". Initial vitals were obtained with HR 80, BP 102/70, SpO2 99% at 1530. She continued to complain of "fuzziness" in her vision. The patients breathing appeared unlabored, but she was visibly shaking and was red and flushed. Continuous pulse ox and heart rate was implemented at this time.          This RN and another RN continued to monitor the patient. At 1535, patient began to complain of itchiness in her mouth. At that same time, this RN administered 50 mg PO benadryl to the patient. Continued to monitor patient throughout. Pt drank plenty of water during this time and started to appear less flushed. Her respirations remained unlabore. At 1345, HR 95 and SpO2 99%. She stated that her blurry vision was beginning to resolve.          At 1605, HR 85, SpO2 99%. Pt stated that itchy throat was beginning to resolve. Continued to monitor. Throughout this time, patient stated that she did not want to go the ER. Consulted with Health Center to see if they had a provider available to assess the pt before she went home. Center had an opening in their schedule and was able to see the patient.          At 1615, HR 75, SpO2 99%. Pts cough became less frequent. She stated that she was feeling better. Walked the patient upstairs to Health Center and stayed with her until their staff roomed her. This RN called the patient the next morning (3/6/24). She stated that center wanted her to be monitored at the hospital, but she declined. They are having her take anti-histamines for the next 4-5 days. She states that she feels tired and has a sore throat in this call.