Report from Emergency Department provider  HISTORY OF PRESENT ILLNESS:. Patient reports that he is having an allergic reaction to his fourth Pfizer COVID-vaccine.  He got the vaccine and approximately 15 to 20 minutes later started having wheezing that has aggressively worsened.  He feels short of breath and has had wheezing.  He denies any chest pain No nausea, vomiting, or diarrhea.  No abdominal pain or lightheadedness.  No rashes or skin lesions.  Reports a history of asthma as a child though nothing recently. REVIEW OF SYSTEMS: Constitutional: No fevers, no chills, no diaphoresis, no weakness, no fatigue Eyes: No changes in vision Ears, Nose, Mouth, Throat:  no sore throat, no swelling in the throat Respiratory: above Cardiovascular: No chest pain, no palpitations, no edema, no syncope Gastrointestinal: No abdominal pain, no nausea, no vomiting, no diarrhea Hematologic/Lymphatic: No h/o DVT/PE or use of blood thinners Musculoskeletal: No arthralgia, no myalgia Skin: No rash, no skin lesions, no jaundice Neurological: No headache, no focal weakness, no numbness, no altered mental status   PE: VS reviewed Constitutional: Mild distress, appears to be in some respiratory distress Eyes: PEERL, EOMI, normal conjunctiva, no scleral icterus ENMT: Dry mucous membranes, no oropharyngeal edema, pink oropharynx Neck: Supple, intact range of motion Respiratory: He is tachypneic, mild accessory muscle use, expiratory wheezes throughout all lung fields Cardiovascular: Slight tachycardia, regular rhythm, normal cap refill Gastrointestinal: non-distended, Soft, non-tender, no rebound or guarding Musculoskeletal: no deformity, No joint swelling, ROM grossly intact Integumentary: Intact, warm, dry, no rashes on exposed skin Neurologic: Alert & Oriented x 3, CNII-XII grossly intact, no focal deficits, symmetric strength in BUE/BLE Psychiatric: Cooperative, appropriate mood and affect   Treatment: ED Medications The listed medications represent those documented as given by the nurse at the time this report was generated.  Current Medications  Medications   (Trade)  Dose  Ordered  Sig/Sch  Route  PRN Reason  Start Time  Stop Time Status Last Admin Dose Admin  Epinephrine HCl   (EPINEPHrine PF)  0.3 mg  STAT  STAT  IM    10/10/22 10:19  10/10/22 10:22 DC 10/10/22 10:24   Albuterol/  Ipratropium   (Duoneb)  9 ml  NOW  ONCE  HHN    10/10/22 10:30  10/10/22 10:31 DC 10/10/22 10:23   Ondansetron HCl   (Zofran Inj)  4 mg  Q-30 Minutes PRN  IVPUSH  NAUSEA  10/10/22 11:30     10/10/22 11:10   Acetaminophen   (Tylenol tab)  975 mg  NOW  ONCE  PO    10/10/22 12:30  10/10/22 12:31 DC 10/10/22 12:31   ED Course/Procedures Given IM epinephrine and DuoNeb's.  Shortly after the IM epinephrine and even before the DuoNeb's take it started his wheezing began to improve.  Wheezing and shortness of breath completely resolved after the DuoNeb's. -- Patient was observed in the emergency department for a few hours.  He did develop some nausea and vomiting.  When they were finally able to get a temperature on him he was found to be febrile.  I wonder if this represents a viral illness or if this truly was anaphylaxis.  Regardless he is much improved and his blood work is reassuring.  The chest x-ray shows no pneumonia.  Discussed home care and ED return precautions. Critical Care Time Critical Care Documentation:  I have personally spent approximately 45 minutes in the care of this critically ill patient which includes clinical and diagnostic assessment and interpretation, examination of the patient, and discussion of this patient's condition/diagnosis/management plan with other providers. This does not include time spent performing any critical care procedures.  This patient suffers from a condition that acutely impairs one or more vital organ system(s) such that there is a high probability of sudden, clinically significant or life threatening deterioration.  Critical illness: Anaphylaxis Treatment/Management: IM epinephrine, IV fluids, albuterol  vital Signs   Date Time  Temp Pulse Resp B/P (MAP) Pulse Ox O2 Delivery O2 Flow Rate FiO2 10/10/22 12:38     88 Room Air 2.0       92 Nasal Cannula   10/10/22 12:31 39.3        10/10/22 12:04  108 26