Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test, Hypersensitivity, Pharyngeal paraesthesia, Tryptase
Clinical narrative: Chief Complaint Patient presents with ? Allergic Reaction Patient is a 38 y/o F with PMHx ankylosing spondylitis, migraine headaches who presents to ED at request of COVID-19 service line for evaluation of post-vaccination symptoms.  Patient received her COVID-19 vaccine at 1:00PM. She was monitored for 30 minutes without any symptoms. At 2:00 p.m., patient began feeling a sensation of tingling in her throat.  She subsequently called the COVID-19 vaccination hotline and was recommended to present to the ED for evaluation.  She denies all other symptoms including headache, dizziness, lightheadedness, changes in vision or hearing, nausea, vomiting, chest pain or pressure, palpitations, shortness breath or difficulty breathing, wheezing, abdominal pain, pelvic pain, diarrhea, myalgias, arthralgias, paresthesias, rashes or lesions, skin pruritus. She does have an allergy to aspirin and penicillins with reported hives and shortness of breath characterized as anaphylaxis. The history is provided by the patient. No language interpreter was used. This is a new problem. The current episode started 1 to 2 hours ago. The problem occurs constantly. The problem has not changed since onset.Pertinent negatives include no chest pain, no abdominal pain, no headaches and no shortness of breath. Nothing aggravates the symptoms. Nothing relieves the symptoms. She has tried rest for the symptoms. The treatment provided no relief. Review of Systems  Constitutional: Negative for chills and fever.  HENT: Negative for congestion.   Respiratory: Negative for shortness of breath.   Cardiovascular: Negative for chest pain.  Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting.  Genitourinary: Negative for dysuria.  Musculoskeletal: Negative for back pain.  Skin: Negative for rash.  Neurological: Negative for dizziness, light-headedness and headaches.  All other systems reviewed and are negative.     Physical Exam ED Triage Vitals [11/03/21 1446] BP: (!) 147/107 Pulse: n/a Pulse from  O2 sat: (!) 98 Resp: 18 Temp: 98.1 °F (36.7 °C) Temp src: Oral SpO2: 98 %    BP (!) 141/96  | Pulse 76  | Temp 98.2 °F (36.8 °C) (Oral)  | Resp 18  | SpO2 100%      Physical Exam Vitals and nursing note reviewed.  Constitutional:      Appearance: Normal appearance. She is well-developed.  HENT:     Head: Normocephalic and atraumatic.     Nose: Nose normal.     Mouth/Throat:     Pharynx: Oropharynx is clear.  Eyes:     Extraocular Movements: Extraocular movements intact.     Conjunctiva/sclera: Conjunctivae normal.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Chest:     Chest wall: No tenderness.  Abdominal:     General: Abdomen is flat.     Palpations: Abdomen is soft.     Tenderness: There is no abdominal tenderness.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Normal range of motion and neck supple.  Skin:    General: Skin is warm and dry.  Neurological:     Mental Status: She is alert and oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.      Procedures Procedures Resident/APP MDM: 38 y/o F with PMHx ankylosing spondylitis, migraine headaches who presents to ED at request of COVID-19 service line for evaluation of post-vaccination symptoms. Patient received her COVID-19 vaccine at 1:00PM. She was monitored for 30 minutes without any symptoms. At 2:00 p.m., patient began feeling a sensation of tingling in her throat.  She subsequently called the COVID-19 vaccination hotline and was recommended to present to the ED for evaluation.  She denies all other symptoms including headache, dizziness, lightheadedness, changes in vision or hearing, nausea, vomiting, chest pain or pressure, palpitations, shortness breath or difficulty breathing, wheezing, abdominal pain, pelvic pain, diarrhea, myalgias, arthralgias, paresthesias, rashes or lesions, skin pruritus. She does have an allergy to aspirin and penicillins with reported hives and shortness of breath characterized as anaphylaxis.  On initial presentation, patient well appearing in no acute distress.  Vital Signs grossly unremarkable.  Normotensive, afebrile, even, nonlabored respirations at 98% room air, 18 breaths per minute.  Heart regular rate and rhythm, lungs clear throughout with vesicular breath sounds.  No urticaria appreciated on the all layers of skin.  Oropharynx without edema or swelling.  No laryngeal tenderness.   Limited differential includes:  Hypersensitivity reaction, consider early anaphylactoid reaction.  Consider anxiety.   Plan: -labs include tryptase -125 mg IV Solu-Medrol, 25 mg IV Benadryl, 20 mg IV Pepcid.  No acute or emergent need for epinephrine at present.  If needed, consider of 0.3 mg epinephrine if secondary organ system involvement occurs -continue to monitor for clinical signs of anaphylaxis; if stable, discharged with short course of prednisone and strict return precautions   Results: -7:57 PM patient feeling significantly improved.  Will discharge home with continued use of Pepcid and or Benadryl every 4-6 hours as needed, 5 day course of prednisone 40 mg once daily, EpiPen autoinjector in strict return precautions/follow-up instructions.  Patient verbalized understanding and is in agreement with this plan of care.