Patient reports that she received dose one of the Pfizer COVID-19 mRNA vaccine last Friday, February 5, 2021 at 2:03 PM.  She received this here at facility campus vaccine clinic.  She felt a strange tingling sensation immediately upon receiving the injection that extended from the injection site across her upper back but otherwise tolerated the injection well.  Because of her history of food allergy she was advised to remain at the vaccination clinic for 30 minutes.  During that 30-minute wait period she felt generally well however began to develop pruritus at her back in the legs.  She did not mention this to the staff at the vaccine clinic and did not look at her skin.  The pruritus was not too bothersome and she left the vaccine area after 30 minutes and walked down to our clinic to return to work.  Her pruritus intensified very quickly upon returning to her desk and within a few minutes of after her return she went into the bathroom to look at her back and had patches of red, raised, urticarial lesions across her back.  She began to feel itchy all over her body.  She remained at work and did not take any medication or seek any medical help.  She did not look at her legs.  The pruritus intensified and when she looked at her skin of her legs approximately 1 or 2 hours later she had developed urticaria essentially head to toe.  She had large confluent patches of urticaria at bilateral thighs, urticaria at her face, trunk, arms, legs.   At this point she felt otherwise well.  She went home and took 10 mg of Claritin and applied a topical Benadryl cream to her skin.  This was not helpful.  She had severe pruritus of her eyes and eyelids.  She took 50 mg of oral Benadryl which also was not particularly helpful.  Sometime in the middle of the night that night she developed chills, felt feverish, and developed intense muscle and joint aches.  She took an unknown dose of ibuprofen with minimal improvement in muscle and joint pain.  She did have improvement in fever.  Following day was Saturday, she spent the whole day in bed in extreme pain.  She describes the pain at her wrists as feeling as though "somebody was breaking my bones" with any movement of her wrists.  She had pain even laying flat in her bed and had severe pain at all of her joints with movement.  She tried taking a flexeril with no improvement. She recalls a T-max of 102 sometime on Saturday or Sunday.  At that time she had been taking ibuprofen around-the-clock.  She also took 10 mg of Claritin approximately every 4 hours.  Each night she also took 50 mg of Benadryl.  She continued to experience urticarial skin rash and intense pruritus of the skin.  The urticaria waxed and waned during this time.  She also developed a fever blister at her lower lip. She spent most of Sunday in bed also.  She was feeling a bit better by Monday however still had intense pruritus.  Skin rash was much improved at most of her body however she still had mild urticaria at her face.  She did not have a fever on Monday but was continuing to take ibuprofen around-the-clock.  She discontinued ibuprofen yesterday and has not had fevers or chills since Sunday.  At this point her urticaria has essentially resolved. She continues taking claritin 10mg BID to 3 times a day and also 50mg bendaryl at bedtime.    She did not experience any bruising related to this rash however did have excoriation from scratching particularly at her face.   Throughout the course of these days she did not have any episodes of angioedema of the lips, tongue.  She denies difficulty breathing, cough, wheezing, shortness of breath, throat tightening, nausea, vomiting, diarrhea, dizziness, lightheadedness, syncope.   She has a history of oral allergy syndrome with peanut.  Promethazine has caused diplopia, weakness.  Simvastatin caused muscle weakness.  She has never had any issues with vaccines.  She has been getting a flu shot yearly with no difficulty.  Her most recent vaccine was October 8, 2020, quadrivalent influenza vaccine.   No known history of allergy to polyethylene glycol.   No history of chronic urticaria.  She takes NSAIDs frequently without any difficulty.  She has not taken any NSAIDs prior to receiving this injection or developing this urticaria.  She had however taken 10 mg of Claritin prior to receiving this injection.   She has no history of anaphylaxis.  She has undergone surgery under general anesthesia on more than one occasion without issue.  No history of reaction to stinging insect venom.  She receives immunotherapy for inhaled environmental allergens here in our office and has done well with this.   She denies any recent medication changes or new over-the-counter medications.   She has not previously been diagnosed with COVID-19.