Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Hyporesponsive to stimuli, Ocular hyperaemia, Staring
Clinical narrative: Patient expressed concern that first vaccine she acquired some blurred vision about 2 hours after the vaccine and complained of being tired and slight headache. She was advised at that point to strongly consider following up with her Provider and not getting the booster today. She stated she has a new position in the school system and should get the booster and does not wish to follow up with her PCP. She said she was fine and wanted again to get the vaccine booster.  Vaccine booster, Pfizer Lot: ER8727, was given in pts left deltoid at 10:55. Pt tolerated injection well and walked 10 feet to chair in waiting area, where she was visible to me.  Around 11:05, this RN called patient's name and approached pt, as she was noted to be staring into space and not responding to audible cue of her name. She could appropriately answer her name but had to be redirected to the question of her last name x 2. She appeared confused to place and time. Her friend, was called to her side as per patient's request.  After some coaxing, she was assisted with ambulation to a stretcher in the clinic. At that time she appeared to have an unsteady gait. Her VSs at 1110 were BP-191/109, HR 88, O2 96%.  She was able to follow commands with some cuing. She was also able to lift both arms and legs to gravity with moderate strength to resistance. Pupils were equal, reactive and 3mm. She denied any numbness or tingling anywhere, but did complain of a "weird" sensation in her left posterior scalp. No facial droop noted. Her eyes were noted to be blood shot and she stated they had a burning sensation noted.  VSs at 1115 BP 169/103. HR 82, O2 95%  VSs at 1120 BP 180/95, HR 78, O2 95%, at this time patient was advised of the concern of her elevated blood pressure and that we would continue to monitor for about 10 more minutes to see if it would improve. Cognition now almost back to baseline per friend who was at the patient's side. Patient denied history of high blood pressure in the past, but also states she does not routinely follow up with a Provider.  VSs at 1125 BP 192/85. HR 78, O2 94%, at this time patient advised of concern for high blood pressure and associated symptoms she was experiencing and was advised by myself, her friend and Vaccine Clinic RN, to be taken to the ED for a Provider to look at her and a possible evaluation. Pt sat upright on the stretcher and refused to go to the ER. Her friend asked multiple times if she would like a family member to be called and come pick her up if she was going to refuse going to the ER. Patient then stated she was fine and had to go to the bathroom.  Pt escorted by myself to bathroom, gait appeared steady and pt no longer starring into space. Pt accompanied to the bathroom.    Pt accompanied by friend and myself to waiting area and stated she has an appointment tonight to follow up with a Provider at 1830 for psoriatic arthritis and possible steroids. I asked if I would be able to call and talk to this provider to ensure a better transition of care into the community due to not going to the ER. Pt agreed and came back to sit down with me in the vaccine clinic.  Dr. was called and I spoke to him reviewing the aformentioned event to inlcude the patient's VSs. He agreed that when blood pressure initially 191/109 she should've gone to the ER. He then said since the BP was now192/85 that he was okay with her leaving, driving herself back home and seeing him at 1830 tonight, where he would address her hypertention.  Pt was then with steady gait and back to baseline, per friend, escorted back to waiting room nd to her car, where she stated she was going to drive directly back to home. Pt was instructed multiple times if she had any sensation of confusion, dizziness, blurred vision to pull her car over and call 911, also if issues once home to go to ER. She verbalized multiple times her understanding of this information and again did not want her sister called to come and pick her up.