Age: 42.0
Sex: F
Vaccine: COVID19
Symptoms: Anxiety, Arthralgia, Asthenia, Blood folate, Blood thyroid stimulating hormone
Clinical narrative: Had covid pfizer vaccine 10 days ago (Friday) #1 - had a bad couple days - felt "off" - fatigued, SOB, excessive sleepiness, arthralgias for a couple days (Sat/Sun). Felt "useless". Then developed tingling of the left and since that time, she has had left lateral upper arm at area of injection, tingling (pins and needles) of the lateral upper arm and dorsal forearm and to all the fingers. "Like they are asleep". No weakness. No rash. Had some CP (pinch in the anterior lower chest) while sitting in her office today. Left leg has similar sensations of tingling from the knee down. No HA. No vision change. No better or worse than when it started.    She reports that she had a panic attack last Friday. This is also when the tingling sensation begin to happen in her left arm where she got the shot. She denies any previous symptoms similar to this. She notes that she did experience some joint pain after the COVID vaccination. She states that she cannot catch a full breath when taking a breath. She states that her energy is not coming back after receiving this vaccination. POSTIMMUNIZATION REACTION PARESTHESIAS ANXIETY Try steroid pack, Prednisone, to lower symptomatology from immune vaccine reaction. Will take 2 a day for 5 days. If this does not improve symptoms then refer to neurologist. We discussed that I have seen this a couple times with the covid vaccine and with the other cases, the symptoms resolved spontaneously with time though steroid helped a bit with lessening symptoms. I don't see any concerning symptoms for stroke, seizure, MS, etc. We discussed that aggressive evaluation would include MRI now but I believe we could watch and wait to see effects of treatment. However offered if she was uncomfortable with plan, then order MRI. She is open to trying steroid for initial course of action. Follow-up if symptoms do get worse or do not improve and do not take second dose of vaccination for the time being given initial reaction to vaccine #1. Patient presents today for numbness and tingling follow-up.        Had EMG/NCV - normal.        MRI - normal.         When she wakes in the AM, she feels well for 15 minutes, but then at 15 minutes she has tingling of the arms (starting w left then progressing to the left leg then to the right arm then rarely the right leg). She gets associated brain fog with this. If she is sitting or laying, she does not have these symptoms. She perceives swelling of the UE/LE but she notes no true swelling except around the menses. Feels better if she is wearing compression stocking and sleeves. No CP, SOB, palpitations, cough. She notes that she has been trying to not eat as much salt, she usually eats candy, but has stopped. She does not drink soda either. She denies headaches or back pain. She states that she is getting enough protein in her diet.         She reports that she was taking Fluoxetine 20mg, but stopped taking it a couple of days after she started as she had SE. Restarted at lower 10mg dose and now taking that daily without SE. Feels it is taking the edge off her anxiety. She notes that she is not taking Xanax during the day. She is currently taking birth control, a multivitamin, and vitamin D.  Patient was referred to neurology for evaluation  on 8/16/21