Age: 9.0
Sex: M
Vaccine: COVID19
Symptoms: Urticaria
Clinical narrative: 1520: Pt brought over to monitoring area with concerns of a "rash" to pt's injection arm- L arm. RN noted hives to the outer R corner of injection site, several streaks of redness to L axilla, hives to L elbow, hives to L wrist and hives approximately 3 inches to pt's middle back. Pt denies any itching or swelling. -wheezing/stridor and pt denies any chest pain, palpitations, SOB, dizziness or headache. He is smiling and very conversive with staff. Very calm and cooperative. Mom indicated that pt developed a rash the day after pt's 1st dose several weeks ago that self resolved. Mom also indicated pt has a history of anaphylaxis with use of amoxicillin at 3 years old that had required him to use/be prescribed an epipen, however pt has not needed to use it since then and per mom, pt's pediatrician is aware. Also per mom, pt has a history of "hives" with ibuprofen. Antihistamines that are used at home per mom are Benadryl and Children's zyrtec. Pt placed on monitors and VSS, as charted below. Pt is warm, pink and dry. Appears in no acute respiratory distress, very calm and cooperative. Call out to MD provider and provider with no answer. Call out to Dr. and report given. Verbal orders obtained and pt medicated as ordered. Pt tolerated very well and remains in no acute distress. Comfort measures provided. Continue to monitor closely.   98 112/62 77 18 100 on Room Air  1530: Pt reporting feeling "warm" but continues to deny any discomfort or distress. Hives are becoming lighter or even gone in several areas- L axilla, L wrist and middle back. No new symptoms and pt remains with VSS. Comfort measures provided- rest & water and pt tolerating all very well. Continue to monitor.   101/57 87 18 100 on Room Air  1545: Pt continues to deny any respiratory distress and upon further evaluation of pt's symptoms, the hives continue to become lighter however there are noted new hives- 2 dime sized areas and 2 red streaks noted to lower back at the waste line of pt's pants. Pt continues to deny any itching. Evaluation also does not indicate any circumoral swelling/redness. Pt remains speaking in full, clear sentences, continues to be free of any wheezing/stridor, nor does he c/o any tongue swelling. Cap refill <2seconds and VS remains stable as charted below. Continue to monitor closely.   107/63 89 18 99 on Room Air  1600: Area of hives to pt's lower back has lightened up and no longer red or raised but now pink and flat to palpation. All other areas to L arm and middle back has since resolved completely.  Upon further evaluation, there is a new quarter sized redness to R side neck that is not raised. Pt continues to deny any itching or respiratory distress. Continues to speak in full and clear sentences, remaining very calm and cooperative.   106/65 79 18 100 on Room Air  1603: Quarter sized redness to R side neck has now lightened up and decreased to the size of a pea. Pt continues to deny any discomfort or distress, will continue to monitor.   1610: Hives to pt's R side neck has since resolved. Pt has no new hives/redness to body. He continues to deny any discomfort or respiratory distress. He also continues to remains warm, pink and dry. VSS as charted below. Call out to Dr. and update provided. Per MD, pt is okay to release to mom home as pt's symptoms are/have resolved, remains in no acute distress and he does not have any new symptoms. VS rechecked and as charted below. Reviewed EUA, VIS and educational tools for vaccine home care with mom and pt. Both verbalized understanding. Also advised pt and mom to seek medical attention in the ED should pt's symptoms return, worsen, changes or becomes life threatening. Per Dr., if pt's hives return, mom may give childrens Benadryl 25mg po, however any symptoms of anaphylaxis- pt should be evaluated in the ED. Mom verbalizes understanding. Also encouraged follow up with Pediatrician regarding pt's symptoms today and mom verbalizes understanding. Pt remains with no new hives or symptoms. He remains very pleasant, calm and cooperative, speaking in full and clear sentences. Pt road tested and ambulated with very steady gait. Pt released to mom and both ambulated out of Covid Vaccine Clinic without incident.   108/61 76 18 99 on Room Air