Progress Notes COVID VACCINE CLINIC  3/3/2021    Patient is a 66 y.o. female who was seen at 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 15 minute waiting period after the injection, the patient began to experience feeling flushed/nausea.  She denied rash, 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 blood pressure abnormality , hypotension, rapid progression of symptoms, respiratory distress and vomiting.   She reports she took her coreg 25 mg dose torsemide 20 mg doses this am. She did eat toast and yogurt around 7 this am.     Past Medical History: Diagnosis Date ? Biventricular ICD (Medtronic) implanted on 8/19/14 8/20/2014 ? Depression   ? Depressive disorder, not elsewhere classified   ? GERD (gastroesophageal reflux disease)   ? Heart failure (HCC)     LVEF 40-45% by ECHO 1/2012. ECHO 11/13 LVEF 50-55%. LVEF 37% by nuclear stress test 2/20.14. ECHO 4/2014 LVEF 30-35%. LVEF by echo from 3/2017 LVEF 50-55%. ? hospitalization      Admit on: 20111020; Diagnosis: Acute respiratory failure, acute on chronic systolic and diastolic heart failure; at: Stormont-Vail HealthCare; ? Hypertension   ? LBBB (left bundle branch block)   ? Mitral regurgitation     Moderate secondary to annular dilation ? NICM (nonischemic cardiomyopathy) (HCC)     Cardiac cath from 10/2011 normal coronary arteries.  Nuclear stress test 2/2014 no ischemia.          ALLERGY REVIEW OF SYSTEMS:  Patient denies chills, fever, malaise/fatigue, facial swelling, ear pain, sore throat, eyes watering, eyes itching, eye redness, cough, chest tightness, shortness of breath, wheezing, rash, hives, eczema, cysts, itching of skin, abdominal pain, blood in stool, muscle aches, joint pain, dizziness and headaches       Previous Reactions: none    Objective    Vitals Vitals:   03/03/21 0920 03/03/21 0928 03/03/21 0937 03/03/21 1000 BP: 97/50 97/57 112/60 104/58 Pulse: 96 86   68 Resp: 18 16   14 Temp: 98.4 °F (36.9 °C)       SpO2: 100% 100%   100%      Blood Sugar 71 collected at 0922 Blood sugar 103 collected at 0945   Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: She is not diaphoretic.     Comments: Flushed. Negative for diaphoresis  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 and dry.     Coloration: Skin is pale.     Findings: No rash.  Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time.     Gait: Gait normal.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal. Behavior is cooperative.        Thought Content: Thought content normal.        Judgment: Judgment normal.         Assessment/Plan  Treatment included: water, snacks and reclined Follow up response to treatment: good. Patient discharge: Stable to go home and follow up with PCP.  Differential Diagnosis: Systemic reaction (hypoglycemia, hypotension, generalized rash)   Greatly improved after water/snack/reclining. Pt observed for 45 minutes in the bay.  She feels comfortable going home. Her blood pressure drop may be related to her taking two medications that affect her bp as mentioned above. She's improved with hydration and snack. Recommended that she rest, monitor her bp at home. If symptoms worsen or returns, recommend evaluation in ED.  Otherwise follow up with pcp office.    Pt wheeled out with RN and husband.    Pt voices appreciation of her care today.