Age: 49.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Electrocardiogram, Erythema, Incomplete course of vaccination, Joint swelling, Laboratory test
Clinical narrative: Adverse reaction initially reported under temporary VAERS report number 332643 from encounter at vaccination site.  Pt's treatment continued in ED on the same day as vaccination 2/26/21.  Of note, though potentially unrelated, pt was seen for Pericarditis on 4/22 in an outside ED.  Update discovered during routine review of patients with documented COVID vaccine allergy.   At vaccination site: Dizziness, tongue felt numb. BP 154/77 (pulse 85), O2 sat 99%. Benadryl 25 mg and Epipen given.  Update 6/17/21:   Pt has a hx of numerous allergies to medications and food.  Azithromycin (anaphylaxis?), COVID vaccine (itching/dizziness), Doxycycline (rash), Ibuprofen (swelling), Penicillins (rash), sulfa (rash), Gluten, house dust, polyester, cleaning products (SOB).  Pt also has seasonal allergies (unspecified) and intolerances to aspirin, levothyroxine, and percocet. Pt has a PMH of osteoporosis, migraines, hyperlipidemia, hashimoto's disease, hx of H. pylori, GERD, Diverticulitis, Asthma, arthritis, anxiety, anemia, and obesity.  Past surgical hx of tonsillectomy and cholecystectomy.  Recent abnormal labs 1/4/21 TSH 0.08 mcIU/mL,  and 3/13 was 0.01 mcIU/mL. Pt went to the ED directly from the vaccination site.  Pt was biba 2hrs after vaccination.  After Benadryl, pt developed tingling in arms, sob, chest tightness.  After Epi, pt was "jittery" with SOB.  in the ED pt complained of difficulty breathing and difficulty swallowing.  No rash, swelling or wheezing.  Pt is anixous.  Pt was given NS 1000mL, methylprednisolone sod succ 125mg x1 and pepcid 20mg x1 in ED.  Pt improved and was released from ED ~2hrs after presentation.    Pt discharged from ED with prescriptions for the following: diphenhydrAMINE (BENADRYL) 25 mg capsule Take 1 capsule by mouth every 6 (six) hours as needed for Itching.  predniSONE (DELTASONE) 20 MG tablet Take 1 tablet by mouth daily x5days.  Medications at the time of vaccination: gabapentin (NEURONTIN) 100 MG capsule Take 1 capsule by mouth 3 (three) times daily.  gabapentin (NEURONTIN) 300 MG capsule Take 1 capsule by mouth at bedtime. liothyronine (CYTOMEL) 5 MCG tablet Please take 1 tablet in the morning and 1 tablet in the evening thyroid extract, porcine, (ARMOUR) 60 mg tablet Take 2 tablets in the morning and 3 tablets in the evening on empty stomach cholecalciferol, vitamin D3, (VITAMIN D3 ORAL) Take by mouth. 50,000units once a week per pt cholestyramine (QUESTRAN) 4 gram powder Take 4 g by mouth daily.Avoid taking other medications within 4-6 hours before or after the cholestyramine. Take cholestyramine at night with dinner. cyclobenzaprine (FLEXERIL) 5 MG tablet Take 1-2 tablets by mouth at bedtime as needed for Muscle spasms. omeprazole (PRILOSEC OTC) 20 MG tablet Take 1 tablet by mouth every morning 30min before breakfast.  On 4/22/21: Pt presented to outside ED with Chest pain and diagnosed with pericarditis. From Provider Note at outside ED: Assessment and Plan: Per H&P 4/23/21, "50 Y female with history of BMI 53, hypothyroidism, allergic rhinitis, obesity, chronic neck pain, migraine, celiac disease admitted 4/22/21 with shortness of breath, jaw pain."    PERICARDITIS -EKG consistent with pericarditis -ruled out for MI, chest CT angiogram negative for large pulmonary embolus, MIBI normal  -Echocardiogram normal -appreciate Cardiology Service Dr.'s recommendations -start colchicine bid for 1 month, then qday for another 3 months. EOT 8/24/21 -continue indomethacin for another few days RTC then change to prn  MILDLY ELEVATED D-DIMER -Likely related to inflammation from pericarditis   CHRONIC NECK PAIN -home gabapentin (neurontin) 300mg oral 2X per day   REACTIVE AIRWAY DISEASE -On ciclesonide (alvesco) 80mcg 2 puffs 2X per day + albuterol and ipratropium inhaler (combivent) 1 puff 4X per day  -pt reports pulmonary symptoms with allergies sometimes - consider PFTs after pericarditis treated  HYPOTHYROIDISM -home thyroid armor 180 / 120mg oral 2X per day + liothyronine 5mcg daily  ONYCHOMYCOSIS -home terbinafine (lamisil) 250mg daily