Progress Notes Family Medicine 2/25/2021                                                                      Date:  2/25/2021                                                    Subjective Is a 70 y.o. female who was seen at a vaccine Clinic today for her first  dose of the COVID 19 vaccination.    She was given the Pfizer vaccination in the left deltoid muscle.   During her 30 minute waiting period after the injection, the patient began to experience nausea, belching, sob.  She denied rash, hives, welts, hoarseness, stridor, itching, lightheadedness, dizziness, facial swelling, lip swelling and tongue swelling.   This provider was notified of patient reaction and she was then assessed in the emergency bay area.   Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality , rapid progression of symptoms, respiratory distress and vomiting.   PMH: pt reports recently admitted for unstable angina and CAD with tachycardia. Had elevated d-dimer and blood clot was ruled out. Pt dc'd on new medication, beta blocker. Since discharge this Sunday, she reports chest heaviness as if she has "cardboard on my chest."  Can slightly increase with going up and down stairs or increased activity. She states she had reached out to her cardiologist via my chart but has not heard back.  States her pain is about the same today. Upon 15 minutes after injection, she noted nausea with belching and had some sob. Symptoms worsened as she ambulated over to the medical bay along with her chest pressure.       ALLERGY REVIEW OF SYSTEMS:  Patient complains of chest tightness and shortness of breath   Patient denies chills, malaise/fatigue, sore throat, frequent throat clearing, eyes watering, eyes itching, puffy eyes, eye redness, cough, wheezing, rash, hives, eczema, itching of skin, abdominal pain, muscle aches, dizziness and headaches    + nausea and belching:     Previous Reactions: none    Objective    Vitals Vitals:   02/25/21 1000 02/25/21 1008 02/25/21 1013 BP: (!) 157/102 (!) 144/86 (!) 169/94 Pulse: 72     SpO2: 97%            Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is well-developed. She is not ill-appearing, toxic-appearing or diaphoretic.  HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.  Eyes:     General:        Right eye: No discharge.        Left eye: No discharge.     Conjunctiva/sclera: Conjunctivae normal.  Neck:     Thyroid: No thyromegaly.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.     Findings: No rash.  Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.         Assessment/Plan  Treatment included: She has nitro on hand. We gave that at 10:03 am. Follow up response to treatment: fair. Patient discharge: Transported to ED by ambulance.  Differential Diagnosis: Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns)   Firefighters responded first at 1008 Arrived at 1011. EKG done, no acute findings. Pt reports pain at 0 after nitro administration. Belching and nausea reduced. Pt taken to ED for further evaluation.  ED called and given report at 1020   Electronically Signed 2/25/2021 10:24 AM