Age: 58.0
Sex: F
Vaccine: COVID19-2
Symptoms: Lip blister, Lip pain, Lip swelling, Nasal congestion, Oropharyngeal pain
Clinical narrative: Vaccine on Tuesday 10/25 in afternoon.  Tired that night, no other concerns.  Tired on Wednesday 10/26 during day but functional with increasing congestion.   By evening, raspy voice, deeper congestion, tired with sore throat developing overnight. Thursday, 10/27 woke with strong congestion, deeply raspy voice, sore throat.  Symptoms through day included headache, fatigue, stuffy nose, ear aches x2, body aches, sore throat, cough (drainage).  Slept off an on through day, rested. Fever at 100.9 on digital thermometer at 9:48 PM took 650 MG of aspirin.  Fever at 100.2 at 10:11 PM.  Slept through night, temp at 10:56AM was 98.1F on Friday, 10/28 noted fatigue, body aches, sore throat, stuffy nose.  Both arms were beginning to hurt, lower arms at joints.  Call Health Systems nurse call line at 12:34 PM, reviewed symptoms including hands and had stopped using OTC Anti-Itch cream at that point and began with frequent soap / water hand washing routine and Aveeno unscented hand lotion. Nurse confirmed at-home appropriate with aspiring / benedryl but to call or come in if symptoms got worse.  Took Aspirin 325 mg and benedryl.  98.8 F at 12:36PM.  Took picture of rash on left hand at 12:41 PM, spreading up wrist area for comparison.  Rash on right hand was in early stages.  Aspirin 325 mg at 2:30 PM and Benedryl x 1 at 3:30 PM.  99.9 at 5:18 PM and 100.4 at 6:16 PM.100.6 at 9:20 PM and 101.3 at 9:47 PM.  Slept throughout day, fatigue with rash continuing to develop on both hands.  Somewhere in here I began to notice slight swelling on face near left side of lower lip.  By 10:00 PM, headache, rash (swelling still visible in hands), joints aching from swelling.   Ibuprofen 200 mg and benadryl x 2 at 10:09 PM and to bed.  100.9 at 10:26 PM.  Benadryl x1 at 4:30 AM. Urgent Care visit on Saturday, October 29th  with Rx for Prednisone, first does at 1:30 PM.  Bendaryl at 2:40 PM.  Temps 99.5 at 2:45 PM, 99.5 at 6;42 PM.  Slept most of day.   Temp at 98.1 at 8:52 AM on Sunday, 10/30 with stuffy nose, rash, headache and fatigue. Aspriin 325 mg and Prednison at about 9:00 AM.  Temp at 98.6 at 10:42 AM, sudafed and benedryl at 10:47 AM. Temp at 98.4 at 1:59 PM,.  Temp at 98.2 at 9:44 PM, stuffy nose, rash (here's where I see documentation of rash on face, remember slight swelling at lower left edge of lips.  Remember telling my husband I felt pretty good - tired - other than the swelling on face, rash on hands was resolving.  Benedryl x2 at 10:55 PM.  Sleep difficult - "crazy legs" which I assumed was from the prednisone, lip painful and put on Blistex.  Lips more pain, got up shortly after midnight and swelling in lip had increased a great deal - lower lip probably double normal size, took a couple of photos of lip swelling- removed  Blistex and applied cold compress to area.  Little to no sleep.  Temp 98.1 at 3:28 AM on Monday, 10/31.  Aspirin 650 mg  3:30 AM.  Sudafed 6:00 AM.  Woke husband to return to urgent care, swelling of lower lip and now numbness up right cheek and into chin.  Pain in right sinus, have history of recurring sinus infections.  Shortly after arrival at Urg Care, noted that blisters (pockets) had formed on inside of lower lip.  Pain was present in face area, exhausted.  Pain scale rating, probably a 5 of 10 at most. Administered Cetirizine (ZyrTEC) and assessed after 30 minutes.  I could feel some relief.  Discharged to home with continuation of Prednisone (original 5 day course of treatment), Zithromax Z-Pak (new) for sinus infection, and Zyrtex 10 mg daily for 15 days.  Slept the entire day and night.  Severe arm pain in right hand / wrist and left shoulder / elbow developed throughout Monday night.  Noted itching in elbow and underarms beginning sometime that night.  Awoke Tuesday AM, pain scale assessment of pain in arms was at least an 8 of 10.  Took Zyrtec about 4:30 AM.  Took Prednisone sometime between 8 and 10 after making my way from bedroom to recliner, pain was overwhelming, fatigue was significant.  Notable swelling in underarms, above elbows, and behind right knee.  Slept upright in recliner for a few hours, when awoken, pain in arms was diminished but fatigue was awful.  Showered and back to bed for the entire day and night.  Awoke on Wednesday, felt pretty good and was actually functional throughout day.  Final dose of prednisone taken Wednesday morning.  Thursday, I am again slightly fatigued and my neck, underarms, and side of my face are starting to itch.