Age: 9.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal discomfort, Abdominal pain, Dyspnoea, Myalgia, Pain
Clinical narrative: 1348:  I was informed by RN, that patient was in the procedure room for c/o SOB and was in no distress.   1350:  Pt was lying on gurney in supine position with his knees bent. Pt was in no respiratory distress, was able to speak in full sentences without pausing, skin pink and warm, pt alert and oriented, answering all questions appropriately.  Pt's mother at bedside.  Vitals taken: BP 103/71 HR 78 SpO2 99% RA.   1358:  Per pt pain onset shortly after he received the vaccine (at 1321) and he sat down on the chair.  No rash noted, no c/o pruritis, no facial swelling, no angioedema noted, nausea and/or vomiting.  No reports of constipation or diarrhea.  Pt reports he ate prior to coming in to get vaccinated.  Pt continues to c/o left sided abdominal pain, constant, improves with his knees bent towards his abdomen and with pressure to LUQ below ribs.  Worse with movement and when he extends his legs. Mid right quad tender to palpation.  Pt did reports having an episode this type of pain before at home, which also started after sitting down in a recliner.  Pain self resolved.  Pt's mother was unaware of incident.   1402:  I have paged incident to provider, Dr., and given report.  Dr.will come in and further evaluate patient.   1405:  I walked in to procedure room and patient was taking sip of water from bottle.  Pt reported pain was gone and got up from gurney without any difficulty, denied pain or any other symptoms.  Pt was moving freely without assistance or guarding.  Pt was in no distress and had no complaints.   1408:  Called Dr. and informed him of change in patient's condition.  Pt will be discharged from clinic. 1410:  Pt instructed to inform his parents shall he develop any symptoms.  Pt's mother was also instructed to monitor for any sxs of severe allergic reaction such as swelling of the tongue, throat, face, difficulty breathing, SOB, generalized rash, abdominal pain, vomiting, dizziness and / or palpitations. In which case pt should get immediate medical attention.  Pt's mother verbalized understanding and pt left in stable condition without any complaints of any symptoms.  Pt stopped to take a picture with the superhero display before leaving.  No signs of distress noted.           My NoteAddendum 2:18 PM  Addend        Patient is a 9 year old male who has completed a 49-minute observation period with the following signs and symptoms of an adverse reaction: other - abdominal pain. Pfizer-BioNTech COVID-19 vaccine #1 in series administered.  o Action(s) taken: Other - Vital Signs o Allergy to COVID-19 vaccine documented in Allergies activity: Yes o Patient advised to discuss second dose considerations with a clinician   RN     RN   1321-Patient received Pfizer tri-sucrose 0.2 dose. 1338-Discharge time. No known allergies or contraindications, pt was given a 15 minute observation time. Towards the end of observation, pt began to complain to mom of left side upper quaderant abdominal pain.  1342- Pt was moved to procedure room for comfort. Pt denied difficulty in breathing, itching, nausea. Assessment: Pt presented, skin warm /dry, no rash or flushing.  respirations 14/min not labored, pt rated pain as 3/10 reclined with knees up, exacerbated by independent movement 10/10. RN was brought in to consult. Vitals were done, BP, pulse O2 and heart rate all within normal limits. Attempt was made to palpate abdomen but pt was guarding and recoiled saying "it tickles". Overall pt presented relaxed and conversational, no signs of distress with the exception of reported pain. Last oral intake was approximately 30 minutes prior to arrival. Banana, small amount of granola and a partial bottle of water. Last BM within last 24>36 hours. Pt asked for water and took a small sip. Pt related a similar occurrence of a few days ago, which self resolved. Upon hearing the Dr was on his way, pt quickly got up from the bed and said "Mom, guess what, purified water neutralizes the vaccine!" Pt then stated "I'm all better now, let's go home!" Mom agreed to forego seeing the Dr. Pt departed 1410. Both pt and guardian were educated as to when to call HCP and when to call 911.  Pt was able to ambulate unassisted from the clinic.    1348:  I was informed by RN, that patient was in the procedure room for c/o SOB and was in no distress.   1350:  Pt was lying on gurney in supine position with his knees bent. Pt was in no respiratory distress, was able to speak in full sentences without pausing, skin pink and warm, pt alert and oriented, answering all questions appropriately.  Pt's mother at bedside.  Vitals taken: BP 103/71 HR 78 SpO2 99% RA.   1358:  Per pt pain onset shortly after he received the vaccine (at 1321) and he sat down on the chair.  No rash noted, no c/o pruritis, no facial swelling, no angioedema noted, nausea and/or vomiting.  No reports of constipation or diarrhea.  Pt reports he ate prior to coming in to get vaccinated.  Pt continues to c/o left sided abdominal pain, constant, improves with his knees bent towards his abdomen and with pressure to LUQ below ribs.  Worse with movement and when he extends his legs. Mid right quad tender to palpation.  Pt did reports having an episode this type of pain before at home, which also started after sitting down in a recliner.  Pain self resolved.  Pt's mother was unaware of incident.   1402:  I have paged incident to provider, Dr., and given report.  Dr. will come in and further evaluate patient.   1405:  I walked in to procedure room and patient was taking sip of water from bottle.  Pt reported pain was gone and got up from gurney without any difficulty, denied pain or any other symptoms.  Pt was moving freely without assistance or guarding.  Pt was in no distress and had no complaints.   1408:  Called Dr. and informed him of change in patient's condition.  Pt will be discharged from clinic. 1410:  Pt instructed to inform his parents shall he develop any symptoms.  Pt's mother was also instructed to monitor for any sxs of severe allergic reaction such as swelling of the tongue, throat, face, difficulty breathing, SOB, generalized rash, abdominal pain, vomiting, dizziness and / or palpitations. In which case pt should get immediate medical attention.  Pt's mother verbalized understanding and pt left in stable condition without any complaints of any symptoms.  Pt stopped to take a picture with the superhero display before leaving.  No signs of distress noted.           My NoteAddendum 2:18 PM  Addend        Pt is a 9 year old male who has completed a 49-minute observation period with the following signs and symptoms of an adverse reaction: other - abdominal pain. Pfizer-BioNTech COVID-19 vaccine #1 in series administered.  o Action(s) taken: Other - Vital Signs o Allergy to COVID-19 vaccine documented in Allergies activity: Yes o Patient advised to discuss second dose considerations with a clinician    RN      RN   1321-Patient received Pfizer tri-sucrose 0.2 dose. 1338-Discharge time. No known allergies or contraindications, pt was given a 15 minute observation time. Towards the end of observation, pt began to complain to mom of left side upper quaderant abdominal pain.  1342- Pt was moved to procedure room for comfort. Pt denied difficulty in breathing, itching, nausea. Assessment: Pt presented, skin warm /dry, no rash or flushing.  respirations 14/min not labored, pt rated pain as 3/10 reclined with knees up, exacerbated by independent movement 1ura Mendiola RN was brought in to consult. Vitals were done, BP, pulse O2 and heart rate all within normal limits. Attempt was made to palpate abdomen but pt was guarding and recoiled saying "it tickles". Overall pt presented relaxed and conversational, no signs of distress with the exception of reported pain. Last oral intake was approximately 30 minutes prior to arrival. Banana, small amount of granola and a partial bottle of water. Last BM within last 24>36 hours. Pt asked for water and took a small sip. Pt related a similar occurrence of a few days ago, which self resolved. Upon hearing the Dr was on his way, pt quickly got up from the bed and said "Mom, guess what, purified water neutralizes the vaccine!" Pt then stated "I'm all better now, let's go home!" Mom agreed to forego seeing the Dr. Pt departed 1410. Both pt and guardian were educated as to when to call HCP and when to call 911.  Pt was able to ambulate unassisted from the clinic.