Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal discomfort, Anxiety, Dyspepsia, Feeling jittery, Hypoaesthesia oral
Clinical narrative: Patient presented for COVID-19 vaccination today.  She reported that she has struggled with significant anxiety, with a marked increase in sxs and episodes of profound anxiety within the past years. She noted that anything she ?puts in her body? to include immunizations, and medications may provoke profound episodes of anxiety.  She denied any history of suspected adverse reactions to vaccines, but reported significant concern that she would have marked anxiety in association with the COVID-19 vaccine.  I discussed the vaccine with the patient, and encouraged her to have something to eat and drink prior to vaccination.  Offered option of deferring vaccination on the lanai and choosing a different time/place of her comfort for vaccination.  The patient obtained lunch and returned with desire to proceed with vaccination.   We discussed a plan for a conservative 30min observation period post-vaccination.   Immediately upon vaccination, the patient's administering team noted the patient to be visibly shaking. She reported feeling unwell/dizzy.  She reported tongue numbness, indigestion, GI upset and feeling anxious.  She noted that her symptoms were consistent with prior episodes of marked anxiety.  She was provided a glass of water and an ice pack to her neck.  The  team obtained serial VS, which were notable for BPs in the 140s/80s and HRs in the 80s-90s.    The patient was speaking easily in full sentences, and seemed to relax when distracted with conversation about her move to HI from WA, her children, and her Son?s planned Birthday party.  When not distracted with other topics, the patient expressed concern about her sxs, with corresponding increases in jittering/shaking of her legs.   At patient request, the vaccination team phoned her Husband, who joined the patient .  Upon her Husband?s arrival, I asked him if he had observed the patient look and feel similarly to her symptoms on the lanai.  He reported that indeed, he had been with the patient experiencing the same sxs ?on many occasions?.  He immediately felt the patient?s radial pulse, and noted that her appearance and sxs were consistent with prior episodes of anxiety.    The patient expressed that with prior similar episodes, her Husband?s support and talking have helped to speed resolution of sxs.   She notably had no ocular sxs, nasal sxs, oral sxs, throat sxs, difficulty breathing, or dermatologic sxs.  My colleague and I had assessed the patient prior to her Husband?s arrival. Soon after the patient?s Husband?s arrival, I needed to attend a meeting, and therefore my colleague assumed care for the patient.   Upon my return to the vaccine site approx 45min after my departure, I learned that the patient had markedly improved once her Husband had arrived. After symptom improvement, the patient and her spouse had walked around the vaccine site, walked within the A/C building, and spoke with the vaccine team prior to departing the area.  My colleague obtained VS prior to releasing the patient and patient departure at 1242: HR 149/88, HR 85, Sao2 100% on RA