Progress Notes APRN (Nurse Practitioner) Cosign Needed COVID VACCINE CLINIC  Date:  3/22/2021       Subjective is a 42 y.o. female who was seen at today for her first  dose of the COVID 19 vaccination.    She was given the Pfizer vaccination in the left deltoid muscle.   During her 15 minute waiting period after the injection, the patient began to experience shakiness, feeling faint diaphoresis..  She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, 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 collapse and rapid progression of symptoms.   PMH: HTN (losartan), zoloft and medications for allergies and on ocp.      ALLERGY REVIEW OF SYSTEMS:  Patient denies chills, fever, malaise/fatigue, facial swelling, sore throat, frequent throat clearing, eyes watering, eyes itching, cough, chest tightness, shortness of breath, wheezing, rash, hives, itching of skin, vomiting, abdominal pain, muscle aches, joint pain, dizziness and headaches    + shakiness:       Previous Reactions:  hx of vasovagal to blood work procedures. Hx to vaccines as well but had not had any problems for a while.     Objective    Vitals Vitals:   03/22/21 1140 Resp: (!) 58 SpO2: 98%  pt refused. states bp measurements make her pass out       Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is well-developed. She is diaphoretic.  HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  Eyes:     Extraocular Movements: Extraocular movements intact.     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  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.  Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time.     Gait: Gait normal.     Comments: Hands shaking.   Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.      Abnormal findings above improved after laying patient down flat. Pt feels better and was able to progressively sit up in the chair without reoccurrence of symptoms.     Assessment/Plan  Treatment included: water and rest Follow up response to treatment: excellent. Patient discharge: Stable to go home and follow up with PCP.  Differential Diagnosis: Systemic reaction (hypoglycemia, hypotension, generalized rash)   Resolution of symptoms, suspect vasovagal reaction.  She is back to base line. Monitored in bay for approx  10 mintues. Pt able to ambulate w/o difficulty or w/ assistance. Pt with husband for discharge. He will drive home.  Follow up with pcp as needed. Both patient and pt's husband express appreciation of care today.