Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Lip oedema, Lip swelling, Obesity, Oedema peripheral, Paraesthesia oral
Clinical narrative: Angioedema  She reports she just got her 3rd COVID shot earlier this afternoon. She reports after the 15 minutes were up, she felt some tingling at the injection site and a bit woozy. She is also feeling a bit tingly around her lips. She feels her lips are a bit swollen and maybe her lower jaw/mouth as well. She otherwise was feeling fine and ignored the tingling feeling in her lips. She and her husband were on her way home and in the car, her husband noticed her lips beginning to swell. They became concerned and she came back to the office. She denies any difficulty breathing or swallowing. She has no difficulty talking and doesn't feel her tongue is getting larger.   Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is well-developed. She is obese. She is not ill-appearing or toxic-appearing.  HENT:     Head: Normocephalic and atraumatic.     Comments: Mild edema noted to upper lip    Right Ear: No decreased hearing noted.     Left Ear: No decreased hearing noted.  Eyes:     General:        Right eye: No discharge.        Left eye: No discharge.     Conjunctiva/sclera: Conjunctivae normal.     Right eye: Right conjunctiva is not injected.     Left eye: Left conjunctiva is not injected.     Comments: Mild edema to upper eyelids with mild erythema  Neck:     Trachea: No tracheal deviation.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds, S1 normal and S2 normal. No murmur heard.  No friction rub. No gallop.   Pulmonary:     Effort: Pulmonary effort is normal. No tachypnea, bradypnea, accessory muscle usage or respiratory distress.     Breath sounds: Normal breath sounds. No stridor. No decreased breath sounds, wheezing, rhonchi or rales.  Chest:     Chest wall: No tenderness.  Musculoskeletal:     Right lower leg: Edema (trace) present.     Left lower leg: Edema (trace) present.  Skin:    General: Skin is warm and dry.     Findings: No rash.  Neurological:     Mental Status: She is alert and oriented to person, place, and time.     Motor: No abnormal muscle tone.     Coordination: Coordination normal.     Gait: Gait normal.  Psychiatric:        Attention and Perception: She is attentive.        Speech: Speech normal.        Behavior: Behavior normal. Behavior is cooperative.        Thought Content: Thought content normal.        Cognition and Memory: Memory is not impaired.        Judgment: Judgment normal.   She was given 50mg of benadryl immediately upon assessment. Her upper eyelids were beginning to swell during assessment. Patient was closely monitored for approximately another 10-15 minutes after benadryl oral administration and the swelling of her eyelids, mouth and face, overall, improved. Her vitals were monitored, particularly, her pulse oximeter was monitored continuously and did not drop below 97%. Her HR averaged in the 90s the entire time. No epinephrine administration was required and EMS/911 was not needed to be called. She was stable for discharge home with strict ED precautions. She will do a steroid taper and then stop at her usual 5mg daily dose. Pepcid was also prescribe for her to take daily while on the steroid taper and she was instructed to take benadryl 25mg every 6 hours for the next 3 days around the clock.   Vitals:  09/03/21 1514 09/03/21 1540 BP: 104/74 (!) 117/82 BP Location: Right Right Patient Position: Sitting Sitting Pulse: 98  Temp: 36.7 °C (98.1 °F)  TempSrc: Oral  SpO2: 98%  Weight: 220 lb 6.4 oz  Height: 5' 2"  Body mass index is 40.31 kg/m².