Age: 47.0
Sex: F
Vaccine: COVID19
Symptoms: Spinal X-ray, Tachycardia, Urticaria
Clinical narrative: D-EMS was dispatched to the COVID vaccine clinic for a pt whom received her vaccine and was now having a reaction to it. C-Allergic reaction to COVID vaccine. H-Pt had her first dose of the COVID vaccine at 1630 and was sitting in the evaluation line. She stated that she began breaking out into hives and called the paramedic. The pt began to feel tingly all over felt as if her mouth was swelling. Paramedic obtained a set of vital signs; placed her onto the 3lead monitor which revealed sinus tach and obtained IV access to administer 50mg of benadryl and 40 mg of pepcid PO. They called for Medic 6 to transport the pt to the ER. A- We found the pt sitting upright a&oX4 skin P/W/D. At the time of our arrival there was no more hives noted on the pt. The pt was nervous and stated that her lips and nose were tingling. She denied shortness of breath or trouble breathing but stated that it was hard for her to swallow. There was no noted swelling to the pts tongue. The pts lung sounds were clear and bilateral. The pt had already recieved a dose of benadryl and pepcid as previously stated. Rx-We obtained a baseline set of vital signs. Paramedic switched the pt from Paramedic 3lead to our own, which revealed sinus tach. We assisted the pt as she stood and sat onto the cot. We secured the pt to the cot per SOGs in the semi fowler position. We loaded the pt into the ambulance.  T-We transported the pt routine traffic to TRH via Medic 6. While en route to TRH we continued to monitor the pts vital signs. The pt stated that it didnt feel like she was having trouble breathing but she felt as if she couldnt take a full deep breath. Lung sounds remained clear and bilateral with a o2 sat of 100% on room air. Paramedic administered 125mg of solu medrol. The pt remained stable. The pt denied any other new or worsening symptoms. Once we arrived at TRH we placed the pt into the ER bed in room 7 via 2 person sheet pull. Report was given to the RN. Medic 6 was cleaned and restocked and we returned to service.  History of Present Illness This is a 47-year-old Caucasian female who presents to the emergency department by EMS due to symptoms resulting after receiving Pfizer COVID-19 vaccination today.  It was her first shot.  She developed some tingling in her lips as well as some difficulty swallowing.  She did not have any respiratory difficulty.  EMS gave her Pepcid, Benadryl, Solu-Medrol prior to arrival.  Upon arrival she is still having some symptoms of difficulty swallowing.  She is quite anxious.  She states that she was feeling fine prior to the vaccination.  Imported information including vital signs, nursing notes, allergies, past medical/social/family/surgical history reviewed Routine PPE including gloves if indicated, face mask, eye protection worn during the patient encounter ssessment: Possible adverse reaction to vaccine versus anxiety.  Patient was initially seen by Dr. and had medical screening exam performed.  He had ordered epinephrine and 0.5 mg of lorazepam.  The patient remains tachycardic and states she feels like she is having problems swallowing.  On exam there is no stridor.  She is able to swallow her secretions.  I do not appreciate any neck swelling.  Chest is clear.  No focal neurologic findings. EKG My EKG interpretation: Sinus tachycardia with a ventricular rate of 110.  No acute ST elevation, T wave inversion, ST depression Reexamination/Reevaluation Reevaluation: Patient's potassium is 3.2.  CO2 is 19.  That is consistent with hyperventilation.  Other labs are normal except for glucose of 229.  Soft tissue neck x-ray was obtained and that showed some possible airway inflammation and therefore CT scan will be done to more effectively characterize the findings.  Patient received potassium replacement as well as additional Ativan.  She will also be given some IV fluids since she remains slightly tachycardic.  That could be lingering effects of the epinephrine The patient's D-dimer was normal.  She felt better after Antivert and Lopressor. Heart rate remained below 100 and but other vital signs were normal.  Dizziness was better Diagnosis/Disposition Adverse reaction to vaccine Patient Instructions Drink plenty of fluids.  Watch for worsening symptoms  of difficulty swallowing, shortness of breath, facial swelling.  Antivert for dizziness.  Work note for tomorrow.  Recheck with your doctor sometime within the next 3 weeks to see if you should get the second dose of the vaccine.  Return to the emergency department if worse or new symptoms. RX Given meclizine: 1 tab, PO, TID, dizziness/motion sickness, # 20 tab, 0 Refil(s)