Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Hypersensitivity, Metabolic function test, Pain, Pain in extremity, Swollen tongue
Clinical narrative: 3/6/21  This is a 32-year-old female who is receiving her first Johnson & Johnson Covid vaccine and shortly afterwards developed some throat itching and tightness.  She was given a milligram of epinephrine by intramuscular injection by retired emergency physician there and then transported by ambulance here for further evaluation.  Says her tongue felt a little swollen as well but she denies any respiratory symptoms.  Her voice sounds crackly to her.  She denies any pruritus or rashes.  She has had multiple allergic reactions to medications in the past but never having to be admitted overnight.  One episode however did occur while she was hospitalized and receiving treatment.  She has never had to be intubated.  She has had isolated urticaria without oral or throat symptoms and vice versa.  At this point she says she does feel somewhat better. She is given IV dexamethasone and observed here.  At 1 point she complained of it complaint complained of it feeling like a tightening in the back of her throat was worsening.  She is given an additional intramuscular dose of epinephrine with epinephrine and on reexamination had no significant change in physical findings or her phonation.  This occurred again and she was given viscous lidocaine with minimal improvement in her symptoms.  After several hours of observation without objective worsening but continued complaint of feeling increasing tightness in her throat, CT imaging of the neck is performed to assess the soft tissue structures.  No abnormalities or indication of significant retropharyngeal or paralaryngeal edema or airway compromise present. Given the possibility of some laryngeal muscle or parapharyngeal muscle spasm as him, she was given Flexeril.  After some discussion with her I did indicate to her that I felt it would be safe to return home but offered admission for observation as well.  She indicated she was comfortable returning home for continued observation.  She will be continued on steroids and antihistamines and is given additional Flexeril by prescription if this does seem to help her symptoms.  If no improvement over the next 2 to 3 days and follow-up either with her primary providers through facility or Dr.  3/7/21: Return to ED. The patient is in no respiratory distress.  She has no wheezing.  On physical exam her throat lips and tongue look fine.  I think she is not a had another allergic reaction, rebounded from yesterday.  She is not on any type of steroids sinus syndrome with some Decadron.  And she is allergic to Benadryl but she can take Claritin if she wants.  Her CBC and chemistry were normal.  I went back to evaluate her and she still getting fluids and now she is complaining of shooting pain down her left leg from the EpiPen.  Again she has this regional complex pain syndrome that could be part of that but there is nothing I can do for this at this time.  In terms of her allergic reaction she feels much better her throat feels normal.  We will send her out with prescription for Decadron and EpiPen and if she gets worse she will come back and will follow up admit her.