Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoaesthesia, Hypophosphataemia, Immediate post-injection reaction, Injection site hypoaesthesia, Malaise
Clinical narrative: In Clinic: Pt received Moderna vaccine on right arm. She immediately felt numbness and tingling sensation on both shoulders and right neck. Neck felt tight, pain and + weakness on left wrist and 4th / 5th digit. BP was 149/ 78, O2 sat 99%, pulse 82.  Pt then felt nausea, dizziness, burning sensation of left thigh, "not feeling well". Pt abvle to move all extremities, denies SOB. Hx of allergic reaction to Reglan and compazine. Repeat Vitals: 160/74, pulse,83,O2sat 100%, 2 pm: 135/85, pulse 75, O2 sat 99% Paramedics was called and arrived at 2:11 pm. Pt to be further evaluated in ER.  In ED: Gen: Patient is in NAD, non-toxic appearing, cooperative HEENT: NC/AT, MMM, no conjunctival injection, b/l sclera anicteric.  Mallampati 1 oropharynx clear, no exudates, tonsils within normal limits.  No edema or erythema. Neck: Supple.  Cardiovascular: RRR Pulmonary/Chest: CTAB, no increased WOB, no respiratory distress, no wheezes/rhonchi/rales, chest wall tenderness.  Abdominal: Soft. NT/ND, no r/g, no masses  Extr/MSK: Well perfused, distal pulses intact. No tenderness. No LE edema.  Back: No CVAT  Neuro: No evidence of facial droop, normal speech, mentation appropriate, steady gait.  Sensation intact to light touch to upper lower extremities.  Cranial nerves 2-12 within normal limits. Psychiatric: Normal affect. Mood not labile nor depressed.  Skin: No rashes, lesions, or wounds appreciated on exposed skin.    ED Course & Clinical Decision Making: 43 year old  female with PMHx as listed in HPI presents with intermittent numbness after receiving the coronavirus vaccination.   - History of present illness also notable for symptoms started 20-30 minutes after receiving the coronavirus vaccination.   - Vitals reviewed and all wnl   - Physical exam notable for neurologically intact, no rashes, no airway abnormalities, otherwise unremakrable.    - Given above findings, presentation is concerning for side effects from the coronavirus vaccination, electrolyte abnormality.  Will check basic lab work here in the emergency department.  Will give symptomatic control with 1 L of IV fluids and Zofran for the nausea.  Will monitor here in the emergency department.  Disposition pending clinical improvement.   Lab work grossly unremarkable here in the emergency department.  Mild hypo phos of 2.6.  Electrolytes otherwise within normal limits.  No leukocytosis.  Hemoglobin of 10.2, no baseline but the patient does have a history of chronic anemia given uterine fibroids.   The patient was able to ambulate with steady gait.  She continues to have burning sensation to her left leg and her right arm.  She will be given lidocaine patches for symptomatic control.  She also be given ibuprofen 600 mg.   Return precautions returning to the patient.  At this time presentation does not appear consistent with anaphylaxis.  Min presentation most consistent with side effects from coronavirus vaccination.   Patient tolerated p.o. here in the emergency department.  She was able to ambulate with steady gait.  Symptoms mildly improved after lidocaine patch and ibuprofen.  Return precautions given.   Patient re-evaluated and is stable for discharge.    At this time, suspicion is low for acute injury/illness requiring hospital admission or emergent intervention. No indication for inpatient management; No medical or surgical emergent care needed at this time.    However, it was stressed to the patient that symptoms may persist or worsen, in which case she should be reevaluated. Patient should also get appropriate and timely follow up for further evaluation and continuation of care. The patient indicates understanding of these issues. Patient is ready for discharge. Return precautions (advised to return to ER if their symptoms persist, change, or worsen) and follow up plan reviewed with patient and understood.