Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Blood immunoglobulin A, C-reactive protein normal, Choking sensation, Cough
Clinical narrative: Approximately 8-9 hours after receiving her first Pfizer COVID vaccination (around 9 or 9:30pm on May 18, 2021), the patient developed facial swelling and red, blotchy rashes around the bridge of her nose, between her eyebrows, on the top of her right ear, and on her eyelids. She wanted to see what her symptoms would do so we waited 24 hours from her vaccination time before giving her one dose of Benadryl (50 mg) at 1:30pm on Wednesday May 19. The first dose of Benadryl did help her eyelids appear better. However, by the evening of Wednesday May19, 2021, we noticed a "whistling" sound to her voice when she would try to talk. By Thursday May 20, 2021, she began to struggle some and cough while eating around 3 or 4pm. By 9:30pm that night (5/20/21), she was experiencing a tight/choking feeling in her throat and was having enough trouble breathing that we went to a the Hospital ER. While at the ER, they tried to give her a shot of epinephrine, but unfortunately the epinephrine did not help improve her symptoms of the tight, choking feeling in her throat and the struggle to breath. In the ER, she was advised to take Zyrtec instead of Benadryl because Zyrtec has less side effects. She took her first dose of Zyrtec on Friday May 21, 2021, at 12:30pm. Around 10pm on Saturday May 22, 2021, she noticed decreased swelling in the top of her right ear and bridge of her nose, less of a tight feeling in her throat, and she was having a "louder" more normal sounding voice.  By Monday May 24, 2021, her face was back to it normal appearance and her throat was doing better. Yet her throat has never returned to 100% since her first COVID vaccination. Beyond that, this event has seemed to initiate a wave of issues and symptoms that continue to this day. We began with the allergy clinic and saw a doctor after receiving the COVID vaccination. The doctor referred us to the GI clinic where we saw another doctor. That doctor ordered an esophagram to determine if any reflux or long-term damage of the patient's esophagus was evident, but a cricopharyngeal bar was discovered through this procedure. The doctor referred us to the ENT clinic where we met with another doctor. That doctor performed a FEES exam in her office and noted that she witnessed food getting stuck in the patient's throat and lateral sidewall squeezing with swallowing. On August 13, 2021, the patient had surgery at the Hospital that included a botox injection by ENT for her cricopharyngeal bar and an upper endoscopy for GI. In November 2021, she began to experience abdominal pain, loose stools, and occasional oily residue in her stool. In January 2022, she has begun to have daily headaches which cause her to be sensitive to light. We made an appointment with her regular optometrist, she ruled out any eye issues as being the cause for the patient's headaches. In April 2022, the patient has begun to have join pain and swelling particularly in her knees and hands. She has had bright red patches appear on her knees that are warm to the touch and the back bend of her knees appears swollen. Her hand joints can feel stiff and sore to her at times and have developed small bumps at the knuckles. She will occasionally now struggle with mouth sores as well. For her headaches, we were sent to the Neurology clinic. For her joint issues, we were seen by the Rheumatology clinic. We have also had a virtual appointment with the Psychology department to help the patient find coping mechanisms for the pain. We have had ongoing tests and lab work as detailed below. At this point, we believe that rheumatology is considering the patient to have fibromyalgia as they have allowed her to join a study for patients dealing with fibromyalgia.