Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Angioedema, Anxiety, Chest discomfort, Dizziness, Hyperventilation
Clinical narrative: 56 yo Female had a symptoms of anxiety and hyperventilation syndrome (  likely associated anxiety) . She has prior history of anaphylaxis to bee sting and treated in the hospital 1-1/2 years ago.  She also had allergy to oral Lipitor (?(verbal history) oral mucosal swelling but not anaphylaxis) She also has history of anxiety.  She did not indicate any Only meds include Lipitor. She was sleep deprived ( 5 hrs of sleep ) last night . She received her 1st Pfizer IM  dose at 11:17 am and 18 minutes later ( 11:35 am) called the attention of the nurse that she had  numb sensation of her lips and peri oral area, ?itchy with  burning sensation of her throat?,  but able to breath well without tongue or throat tightness.  She admitted she felt nervous , and felt transient chest tightness .  She continued to be alert and oriented, appeared pink , no near syncope but was breathing deep and fast ( 22/min) with sigh breaths.  She was alert , oriented to place and person but lightheaded.  No focal weakness or deficits, but her lips felt numb with paresthesia , mild localized angioedema of lips, tongue appeared normal with Mallampati score 2.   Initial vital signs showed stage 2 hypertension , 144/88 mmHg ( MAnual BP) , HR 63/min SpO2 97-98%, RR22/min, with occasional sigh breaths.  She did not develop stridor or hoarseness throughout observation.  She was moved to a Gurney, HOB  45 degrees , transferred from observation area to another area for close monitoring. VS  were repeated every 10 minutes , BP ranged from 137/78 to 142 /84 mmHg, SpO2 98% on room air, RR 20-22/min.   HR 60 to 63/min .  On exam , remained alert and oriented to time,place and person, verbalized chest tightness at the onset ( 11:35am)  resolved after knowing she had no throat tightness, no stridor ,  her Lungs were clear to auscultation.   She did not develop stridor , appeared comfortable , with normal voice tone and clear speech ; her lips had subtle angioedema ( subjectively felt thick ) but did not progress, tongue normal on exam  without angioedema. Eye exam normal, no eyelid swelling.  Chest  clear breath sounds to auscultation, no wheeze, Heart RR,normal resting HR , no murmur , good and equal radial pulses.  Distal Upper extremities were initially cold to touch , pink, but eventually became warm and well perfused. Due to localized  sensation of numbness of lip with subtle angioedema,  She  was kept under close observation until full recovery. We deferred epipen auto injection since she did not progress to anaphylaxis, had no stridor, no throat tightness , resolved ? burning sensation? of throat, no hypotension, no wheeze and with improved sense of well being within the subsequent 30 minutes and 60 minutes of  observation .  She indicated that her experience with bee sting was worse,  felt better today .She was given diphenhydramine 25 mg PO which she took without difficulty.  She was able to sit up, brought to the restroom to urinate accompanied by female EMTs,  was transported via wheelchair and upon return insisted on walking without difficulty, had normal gait.  She allowed to rest for another 20 minutes ( total of 80 minute observation.  She was  able to stand up, observed to have normal gait , was escorted to her car with no further incident.  She verbally agreed to have her condition reported to VAERS.  Since she was given Benadryl 25 mg PO which she drank with water without difficulty.   She was not allowed to drive her car, and her mother picked her up form the vaccine clinic.  VS upon discharge : BP with mild hypertension 138/82mmHg, HR 62/min, RR20/min, Sp02 98% on room air.  She was advised to monitor symptoms at home ( based on Pfizer handout guidelines which was discussed with her). If she has similar symptoms of anaphylaxis ( similar to her bee sting 1-1/2 year ago ) advised to give herself Epipen autoinjector which she has at home, to inform her Mom , and call 911.   Follow up phone call done 6 hours after the incident , she answered her cell phone, had normal voice tone without stridor and verbalized she is feeling better , no recurrence of symptoms , no other concerns.  She was advised to follow up with her PCP for further advise regarding BP control.  Based on above events , we discussed with her to avoid  mRNA COVID 19 vaccine and discuss alternative COVID 19 vaccine with her PCP.  She verbalized understanding .