Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Muscle tightness, Oropharyngeal discomfort, Paraesthesia oral, Peripheral coldness, Pharyngeal paraesthesia
Clinical narrative: The Patient has an anaphylactic history to an oral pain medication she didn't know the name of, food allergies, and to the flu vaccine (with eggs). She has gotten the flu shot without eggs and been fine. The administering RN asked the med led to further assess. We discussed that she is at a higher risk for anaphylaxis than most people given her allergy history. She said that she was not Allergic to any component of the covid 19 vaccine when shown the list, and this was double checked. We discussed that if she gets the vaccine and has a reaction, she will need emergency room treatment and that she may want to consider being vaccinated at a hospital where they have more resources. However, given she did have known anaphylaxis to a component of the vaccine we will give it to her if she so chooses. It was explained that if she gets the vaccine, we will monitor her for 45 minutes, and if she has a reaction, she will be treated and sent to the E.R. She verbalized consenting to getting the vaccine after being thoroughly educated.  She was vaccinated at 1337 with 0.5 ml of Moderna Vaccine in the left deltoid. I was not present upon the administration. I was informed shortly after administration that she had cold sweaty palms and felt a little lightheaded. She was placed in a wheelchair and taken to a private observation tent to be further assessed. Initially in the tent she was not showing alarming signs of anaphylaxis and appeared stable. She had clear lung sounds and her oxygen level was 99% with no respiratory distress or airway compromise. At 1405 she felt her lips and throat get tingly and slightly bigger, although upon assessment they did not appear swollen. She was fasting and refused to swallow water or Benadryl when offered. She was able to swallow her spit with no issues. We explained to her that we are going to keep monitoring her, but if things change at all we are going to have to call 911 and administer epinephrine. She kept saying she is fine and that she did not want it and that her boyfriend would take her home. Currently her VS were BP 94/70, HR 72, O2 99%, RR 22. She was rubbing her back and her lungs were clear.  At 1410 her bp was 90/62, HR 74, o2 98% and RR 24. Again, she was rubbing her back. Her lungs sounded clear. At 1415 her BP was 84/60, HR 80, O2 93%, and RR rate of 30. She had small expiratory wheezes when listening to her breath sounds. She appeared to be in respiratory distress as she was coughing and rubbing her chest. She stated her chest felt back, neck, and chest felt tight. She still stated she was fine, and she did not have insurance. She was informed that this was a life-threatening emergency  At this time 911 was called as it was determined she was having an anaphylactic reaction needing epinephrine. Her Emergency contact was notified as he was on the phone with her. At 1417 0.3 mg of epinephrine was administered into the left deltoid, which is where I was informed, she had received the vaccine. At 1420 her VS read 118/74, HR 122, O2 99%. Her respiratory distress appeared to be improving, and her VS improving. She stated she felt better, and she wanted to go home, but per policy she was taken to EMS in a wheelchair. She was handed off to EMS around 225 and verbal report was given. She was transferred to her emergency contact was present for transfer and filled in of the events.