Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Pharyngeal swelling, Pruritus, Throat irritation, Urticaria
Clinical narrative: DATA:  2:45pm: Pt scheduled for first dose Moderna COVID-19 vaccine today. Allergies and appropriateness for injection reviewed with pt prior to immunization. Pt reported bell pepper allergy only and denied prior use of epi pen. Pt received immunization at 2:45pm and waited in waiting room for 15min.  3:00pm: This RN evaluated pt for response to vaccine. Pt reported her neck was itchy, anterior neck assessed which showed multiple red "hive-like" spots. Pt was brought back to procedure room and informed that a provider would need to evaluate her. Provider evaluated pt. This RN then assisted per provider with interval vitals and assessments and medication administration of the following:  3:06pm VITALS: 123/80 bp; 73 HR  3:07pm MEDICATION: Administered per verbal of BJB solumedrol 125mg/2ml (lot AK5128, exp 10/21), 2mL administered in R dorsal gluteal. Pt had site tenderness, otherwise tolerated well.  3:07pm MEDICATION: Diphenhydramine 25mg two capsules administered to patient. Exp 1/2021.  3:20pm VITALS/LUNGS: 128/78 bp; 58 HR; 96% O2 on room air; clear lung sounds bilat.  3:35pm Pt reported feeling dizzy and that her throat was itchy. Vitals and assessment done by this RN; provider called in to room who evaluated further.  3:35pm VITALS/LUNGS/THROAT: 125/87 bp; 69 HR; 97% O2 room air; clear lung sounds bilat; throat check, no visible swelling.  3:50pm Pt reported feeling hot as well as throat slightly swelling. Denied dizziness. Vitals and assessment done by this RN; provider called in to room who evaluated further.  3:50pm VITALS/LUNGS/THROAT: 108/79 bp; 66 HR; 98% O2 room air; clear lung sounds bilat; throat check, no visible swelling.  4:04pm MEDICATION: This RN administered per verbal of BJB, Epi pen 0.3mg lot OFM128 exp 09/30/21 in to pt's right vastus lateralis. Pt tolerated well.  4:05pm VITALS/LUNGS/THROAT: 120/79 bp; 68 HR; 97% O2 room air; clear lung sounds bilat; no visible throat swelling.  4:15pm Pt reported lessened throat swelling sensation.  4:15pm VITALS: 116/77 bp; 78 HR; 97% O2 room air.  Pt reported continued sensation of throat swelling sensation to provider. Pt refused EMS and agreed to further treatment of 2nd epi pen and famotidine IV.  4:25pm MEDICATION: This RN administered per verbal of BJB, 2nd Epi pen 0.3mg lot OFM128 exp 09/30/21 in to pt's left vastus lateralis. Pt noted site tenderness upon injection, otherwise tolerated well.  4:35pm MEDICATION: Pt began IV drip of famotidine 20mg/50ml over 15min through  left arm.   4:40pm VITALS: 129/80 bp; 80 HR; 96% O2 room air.  Pt's mother arrived to help pt home.  4:45pm VITALS: 126/78 bp; 83 HR.  4:50pm IV disconnected and pt was assisted with transferring to wheel chair.  Discharge instructions for pt included provider recommending she go to ED for further evaluation. Pt refused. Provider sent pt home with #8 capsules of benadryl 25mg PO two Q4-6hrs; x2 epi pen pack of 0.3mg each, lot OFM128, exp 09/2021; provider also gave recommendation for pt to use triamcinalone pt already had on hand at home topically for red spots on anterior neck BID 7-10days and to avoid hot showers. This RN educated patient on epi pen administration, instructing her to try and do it while sitting due to affects on heart; to remove from plastic case, remove blue top, and to dart perpendicularly into outer middle thigh, hold for 3 seconds. Pt instructed to contact office for any questions and to seek emergency medical care for any worsening. Pt referred to allergist for consultation and approval for 2nd COVID-19 Moderna dose. Pt stated understanding.