Progress Notes (Nurse Practitioner) ? ? Family Medicine Cosigned by:  MD at 2/28/2021  7:38 AM Expand AllCollapse All    COVID VACCINE CLINIC 2/26/2021    Patient:                                                                             Date:  2/26/2021                                                                                               Subjective  is a 37 y.o. male who was seen at COVID Vaccine Clinic today for his first  dose of the COVID 19 vaccination.    He was given the Pfizer vaccination in the left deltoid muscle.   During his 15 minute waiting period after the injection, the patient began to experience flush feeling with chest pain to L lower chest.  He 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 he was then assessed in the emergency area.   Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality  and rapid progression of symptoms.   PMH: none.    Ate a "big baked potato" about an hour an half before coming in .   ALLERGY REVIEW OF SYSTEMS:  Patient denies chills, fever, malaise/fatigue, ear pain, sore throat, frequent throat clearing, eyes itching, eye redness, cough, chest tightness, shortness of breath, wheezing, rash, hives, eczema, itching of skin, muscle aches, joint pain, dizziness and headaches    No vision changes:  + lightheaded. :     Previous Reactions: none    Objective    Vitals Vitals:   02/26/21 1624 02/26/21 1635 BP: 137/88 123/73 Pulse: 59 62 SpO2: 100% 100%    Physical Exam Constitutional:      General: He is not in acute distress.    Appearance: He is well-developed. He is not diaphoretic.  HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.  Eyes:     General:        Right eye: No discharge.        Left eye: No discharge.     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.     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.  Neurological:     Mental Status: He is alert and oriented to person, place, and time.     Gait: Gait normal.  Psychiatric:        Attention and Perception: Attention normal.        Mood and Affect: Mood is anxious (slightly).        Behavior: Behavior normal.        Thought Content: Thought content normal.        Judgment: Judgment normal.    Chest pain and symptoms resolved after taking off mask and eating/drinking.     Assessment/Plan  Treatment included: water and snacks Follow up response to treatment: excellent. Patient discharge: Stable to go home and follow up with PCP.  Differential Diagnosis: Vaccine-Related Anxiety (include misc mental health) and Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns)   Monitored for approx 15 minutes. Pt greatly improved. CP resolved within 1 minute of being in the bay after drinking. VS stable/improved. Pt ambulated out of the medical bay w/o assistance.  Recommended protein based food and hydration 30 minutes prior to next vaccination. Follow up with pcp as needed. Pt voiced understanding and is appreciative of today's evaluation.   APRN Electronically Signed 2/26/2021 4:28 PM