Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Pruritus, Tachycardia, Upper respiratory tract congestion
Clinical narrative: Itching; Allergic reactions; Tachycardia; Numbness and tingling in her mouth; Numbness and tingling in her mouth; Feeling of congestion in the back of her throat; was not able to swallow; Feeling of congestion in the back of her throat; was not able to swallow; Patient cannot talk in complete sentences; This is a spontaneous report from a contactable physician.A 34-years-old non-pregnant female patient received first dose of bnt162b2 (BNT162B2, PFIZER-BIONTECH COVID-19 VACCINE, Solution for Injection), via an unspecified route of administration on 18Mar2021 (Batch/Lot Number: EP7534) as dose 1, single for covid-19 immunization.Medical history included fibromyalgia, migraine, connective tissue disorder, depression and anxiety.Concomitant medications included diphenhydramine hydrochloride (BENADRYL), clarithromycin (CLARITIN), cetirizine hydrochloride (ZYRTEC) and prednisone.The patient previously took prednisone and experienced nausea, tachycardia, irritability, agitation, gastritis got worst and sleep deprivation, Took meloxicam and experienced depression, took pantoprazole was not working and took Benadryl caused PEG (Polyethylene glycol) sensitivity.The patient did not receive any other vaccine within 4 weeks prior to the COVID-19 Vaccine.The medications within 2 weeks of vaccination included prescribed medicines, store bought medicines, dietary supplements and herbal remedies.On 18Mar2021, the patient experienced tachycardia, numbness and tingling in her mouth, feeling of congestion in the back of her throat; was not able to swallow, patient cannot talk in complete sentences.On an unknown date, the patient experienced itching and allergic reactions.It was her first Covid shot 20 minutes after she received her shot, she developed tachycardia, numbness and tingling in her mouth and feeling of congestion in the back of her throat. She was able to talk in complete senses but was not able to swallow. She did notify the staff who provide her with the vaccination, and she was called her heart rate was 130 so she had tachycardia, the oxygen level was normal, no shortness of breath or chest pain. Provided her with Benadryl 50 mg, the symptoms improved, she went home but when she returned home she developed numbness and tingling in the back of her throat, throat congestion and she reported to the urgent care where again they gave her Benadryl, Claritin and they told her to follow and Prednisone 50 mg for 5 days, she returned home again tachycardia continued, numbness and tingling, feeling of throat congestion continued. She called the urgent care, they recommended starting Albuterol nebulizer and following up with her Primary care. The patient mentioned that she had a PEG sensitivity which is polyethylene glycol sensitivity at that she hadn't been told that your vaccination had PEG in it which was why she move forward with the vaccination. It turned out apparently Benadryl that gave her PEG which is why her symptoms got worse on Benadryl and the Zyrtec that she was actually taking rather than Claritin because that's what she has also contains PEG and she started developing side effects on Prednisone which included nausea, insomnia, increasing tachycardia, irritability, agitation and sleep deprivation. So, the physician saw her and told her to document everything and start to document her symptoms with Prednisone, but we cannot wean her off Prednisone because the sensitivity issues to all the PEG's. When at home the numbness and tingling returned. Patient sent a message to my office through the web portal. The physician recommended her to take Benadryl 25 mg PO (per oral) q (every) 8hrs (patient took 50 mg because that is what worked) and Claritin 10 mg PO (per oral) q (every) 12 hrs (patient took Zyrtec because this what she had available every q(every) 12 hrs). I mentioned if we could connect for a virtual visit, she might start her on Prednisone for a 5-day pulse. Patient said the Benadryl and Zyrtec initially helped out but after a couple of doses the symptoms returned (tachycardia+ numbness/tingling in the mouth/throat). Patient went to (facility) on 20Mar2021. Patient was noted to have tachycardia w/ normal Pox and her exam was otherwise negative. She did not get a chest x-ray (CXR). Laboratory tests on an unspecified date included blood pressure measurement: 100/70, body temperature: 97.3, heart rate: normal, heart rate: 130 and heart rate: 114, tachycardia w/normal pox on her exam was otherwise negative, oxygen saturation: normal (oxygen level was normal, no shortness of breath or chest pain). Therapeutic measures were taken as a result of tachycardia, numbness and tingling in her mouth, feeling of congestion in the back of her throat; was not able to swallow and patient cannot talk in complete sentences. Patient was discharged on Albuterol nebulizer (patient did not take), Benadryl 25 mg PO (per oral) q (every) 6 hrs, Claritin 10 mg PO (per oral) q (every) 12 hrs and Prednisone 60 mg PO (per oral) qd (once a day) x 5 days. Patient was advised F/U with PCP in 3-5 days. Patient presented today for F/U and to get a 2nd opinion. Patient was currently on Day 3/5 of prednisone (60 mg PO (per oral) qd (once a day). Patient still having symptoms of tachycardia-HR in the office 85 but when rechecked 115.Patient is having numbness and tingling in her mouth currently. Patient has figured out a few things on her own: Patient in the past has a mild PEG (Polyethylene glycols) sensitivity, which usually is not an issue. Since the symptoms she experienced seemed to get worse on Benadryl and Zyrtec she looked to see if they had PEG-they do Patient was able to purchase a Benadryl without PEGF and has started to use this. Patient found Zyrtec did have PEG but Claritin did not-patient switched to Claritin 10 mg PO (per oral) q (every) 12 hrs. Patient felt that taking: Benadryl (w/o PEG) + Claritin 10 mg PO (per oral) q (every) 12 hrs + Prednisone did help. The numbness/tingling+ feeling of congestion in the back of her throat dis resolve. Patient stated that her current issues now include: Persistent tachycardia, Upset stomach with nausea and decrease appetite stated after taking prednisone, Problems sleeping started after taking prednisone, Feels agitated/irritable started after taking prednisone. The patient that certainly prednisone can cause symptoms she is describing above-however to stop that I would need to stop prednisone and since I do not know how long the PEG sensitivity from the Pfizer shot will last, I am not too sure stopping the prednisone is the best choice. So we will try something else and go home there. On PE: HR 114 w/Pox 97-87% on RA w/BP 100/70 & Temp 97.3. Normal OP with mild erythema but no obvious swelling. Patient able to talk without pause. Lungs clear bilaterally. Abd soft NT/ND-I did not palpate the liver. No LEE. Neuro Exam grossly intact. On data review of the 3 approved vaccinations in the US: Pfizer & Moderna contain Polyethylene glycol (PEG) and Johnson & Johnson contains polysorbate. Patient's allergic to PEG allergic to PEG can have a cross reactive hypersensitivity to polysorbate. There is a notation that PEG allergy from the Pfizer & Moderna vaccinations are low and the reaction/hypersensitivity reaction should not last for > 24 hrs. Allergic reactions to COVID Pfizer vaccination most likely PEG additive since the patient has a known mild sensitivity to PEG which probably was activated by the vaccination and made worse by the Benadryl and Zyrtec. It was asked if this patient should get the 2nd Covid Pfizer shot? No-I recommend against this patient getting the 2nd Pfizer shot. Why? I do not known how serious her reaction would be after the 2nd shot-for now after 1 shot of Pfizer she should have 66% protection (of course using all this Benadryl, Claritin and Prednisone might change that) but I do not want to risk this patient having a more severe reaction after receiving the 2nd shot. Patient asked is she should get a different Covid shot:No to Moderna because it contains PEG. I do not see what the benefit to getting J&J Covid vaccination would offer, there is a risk for her receiving this injection and 1st there can be cross reactive sensitivity to people allergic to PEG and polysorbate which is in the Johnson & Johnson vaccination. J and J offers about 66-72% protection which is not much different to what she should get from the single shot of Pfizer Covid vaccination she received. Offered to send Patient for an infectious disease consult or allergy/immunology consult if she would like a 2nd opinion. Patient did give me permission to share her personal information with Pfizer if needed or they want to contact her.   The outcome of the event tachycardia was not recovered and outcome for events numbness and tingling in her mouth, feeling of congestion in the back of her throat; was not able to swallow was recovered, on unspecified date in 2021 and outcome for cannot talk in complete sentences, allergic reactions and itching was unknown.  No follow-up attempts are possible. No further information is expected.\\