Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Anxiety, Blood glucose increased, Blood pressure increased, Chest discomfort, Chest pain
Clinical narrative: Progress Notes APRN (Nurse Practitioner) ? ? Family Medicine    Pt called for follow up s/p covid-19 vaccine done on 02/24/21. She was sent to the ED from here for further evaluation of chest pain. She states her bp continued to be elevated but they gave her an anti-inflammatory shot for her chest pain.  States it helped a little but not much. States last night was "rough" but got better through the night and "honestly I didn't feel better until noon today."  Took her bp today and it was 148/98.  She has not contacted her pcp for follow up.    She was reminded to continue to track her bp and record. It was also recommended that she contact her pcp tomorrow to get in sometime next week to be further evaluated and f/up on bp.  She is aware of when to return to ED for worsening or new symptoms discussed today.    Pt voiced appreciation for the phone call/follow up.  Denies any other questions or concerns.      Progress Notes APRN (Nurse Practitioner) ? ? Family Medicine Cosign Needed    Attempt to call patient for follow up via phone. No answer.    Progress Notes APRN (Nurse Practitioner) ? ? Family Medicine Cosign Needed    Date:  2/24/2021                                                                                   Subjective Pt is a 56 y.o. female who was seen at clinic today for her first  dose of the COVID 19 vaccination.    She was given the Pfizer vaccination in the right deltoid muscle.   During her 15 minute waiting period after the injection, the patient began to experience chest tightness.  She denied rash, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, facial swelling and tongue swelling.   This provider was notified of patient reaction and she was then assessed in the emergency bay area.   Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality , chest pain, hypotension, rapid progression of symptoms, respiratory distress and tongue swelling.   PMH: DM and HTN. She was taken off Actos here in the last couple of weeks and switched over to Glipizide. She also takes 10 mg of Lisinopril at night time. She also takes Morphine BID for chronic pain.      ALLERGY REVIEW OF SYSTEMS:  Patient complains of chest tightness and dizziness   Patient denies chills, fever, malaise/fatigue, sore throat, frequent throat clearing, cough, shortness of breath, wheezing, rash, hives, eczema, itching of skin, abdominal pain, muscle aches and headaches       Previous Reactions: none    Objective    Vitals Vitals:   02/24/21 0915 02/24/21 0928 02/24/21 0939 02/24/21 0945 BP: (!) 155/82 (!) 159/93 (!) 154/79 (!) 156/88 BP Location: Left arm Left arm Left arm Left arm Patient Position: Sitting Sitting Sitting Sitting Pulse: 87       SpO2: 99%            Blood Sugar 185 collected at 0915     Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is well-developed. She is obese. She is not ill-appearing or diaphoretic.  HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.  Neck:     Thyroid: No thyromegaly.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing.  Musculoskeletal:     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: She is alert and oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood is anxious.        Behavior: Behavior normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.         Assessment/Plan  Treatment included: antihistamines and water Follow up response to treatment: fair. Patient discharge: Transported to ED by POV.  Differential Diagnosis: Vaccine-Related Anxiety (include misc mental health) and Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns)   During her stay she was monitored. After zyrtec was administered and she was laying down. She reported to feel a little better. Upon ambulation to evaluate, she reported lightheaded and chest tightness worsening slightly. She states she has her husband out front who is "angry with me for even being here."  We discussed reasons for further evaluation as I am limited here. She declines Ambulance and states her husband won't take her but she would take herself or find a friend.  Pt stable. Taken out in wheelchair. Pt ambulates without assistance.     2/24/2021 11:11 AM