Progress Notes PA-C (Physician Assistant) ? ? Orthopedics Cosigned by: MD at 12/22/2020  9:48 AM         Patient:    Date:  12/21/2020                                                                                             Subjective Patient is a 34 y.o. female who was seen at COVID Vaccine Clinic today for her first dose of the COVID 19 vaccination.      She was given the Pfizer vaccination in the right deltoid muscle.   During her 15 minute waiting period after the injection, the patient began to experience generalized feelings of "not feeling quite right" as well as anxiety/nervousness, nausea and chills.  She denied difficulty breathing, throat tightness, dizziness, chest pain, or other GI complaints.   This provider noticed her raising her hand from across the waiting area and tended to her where she noted the above complaints. she was then assessed in the emergency bay area. She was monitored for severe reaction symptoms, including rapid progression of symptoms, vomiting, hypotension, chest pain, collapse and Respiratory distress.   Past medical history includes anxiety for which she takes Effexor on a daily basis as well as type 2 diabetes, diagnosed approximately seven or 8 years ago during a pregnancy.  She is on oral medication during the day and insulin at nighttime.  She did take her oral medication today and last ate a pasta lunch right before arriving to the vaccine clinic.  Last A1c was 6.5.  Patient states that she generally runs a postprandial blood glucose following a heavy meal of about 180.    She reported a previous history of anxiety and nervousness following vaccinations in the past.  Most recently, she experienced a 30-minute period of anxiety and nervousness following her flu vaccine this past October.  These feelings passed without further incidents.     Review of Systems  Constitutional: Positive for chills.  HENT: Negative for drooling, facial swelling, hearing loss, rhinorrhea, sneezing and trouble swallowing.   Eyes: Negative for redness and visual disturbance.  Respiratory: Negative for cough, chest tightness and shortness of breath.   Cardiovascular: Negative for chest pain.  Gastrointestinal: Positive for nausea. Negative for vomiting.  Skin: Negative for color change, pallor and rash.  Neurological: Negative for dizziness, speech difficulty and light-headedness.  Psychiatric/Behavioral: Negative for agitation and confusion. The patient is nervous/anxious.          Objective   She ambulates into the emergency treatment bay under her own power and without difficulty.  She is seated on the gurney, and continues to answer questions appropriately.   Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is not toxic-appearing or diaphoretic.  HENT:     Head: Normocephalic and atraumatic.     Nose: No rhinorrhea.  Cardiovascular:     Rate and Rhythm: Regular rhythm. Tachycardia present.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.  Skin:    General: Skin is warm and dry.     Coloration: Skin is not pale.     Findings: No rash.  Neurological:     Mental Status: She is alert.     Gait: Gait normal.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.         Assessment/Plan  Stress reaction secondary to vaccine administration and history of anxiety and nervousness following vaccinations.   Vital signs obtained at 1352 with blood pressure at 154/95, mild tachycardia at 109 and 97% O2 saturation on room air.  Patient denies any chest pain, shortness of breath time.   She is given a bottle of water and assisted to lie down with the head of the bed slightly elevated. She continues conversating appropriately without any acute distress.  Vitals reassessed at 1359 with blood pressure of 133/76, heart rate 97% on room air. Dr. at the bedside now.  Suggested obtaining a blood glucose.  Blood glucose obtained at 1405, elevated at 234.  She continues to deny any chest pain, shortness of breath, chest tightness, swelling in the throat, nausea/vomiting or other GI complaints.   Vital signs checked again at 1406 with blood pressure 133/77, heart rate 107 and 97% on room air.   Vital signs last checked at 1415 to reveal a blood glucose of 219, blood pressure 127/82, heart rate 100 and O2 saturation of 97% on room air.  Patient has no additional complaints at this time and reports feeling well.  Her mother has driven her to the clinic today.  She felt that she was able to safely walk out with any issues.  She was assisted by nursing staff and ambulated out of the treatment bay independently.   Treatment included routine surveillance of vital signs at about a 5-minute intervals following notification of her feeling poorly.  Vital signs continued to normalize and remained stable through the duration of her 30 minutes following her vaccination.    Follow up response to treatment: excellent.   Patient discharge:  Stable to go home and follow up with PCP.  Recommend to patient that she present to the ED or call 911 should she develop any symptoms up to and including but not limited to chest pain, shortness of breath, chest tightness, signs or symptoms of angioedema, or syncope.  She expresses understanding the above and has no further questions today.     Orders Placed This Encounter Procedures COVID-19 MRNA  PA-C Electronically Signed 12/21/2020 1:51 PM