COVID VACCINE CLINIC        Subjective Patient is a 38 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 left deltoid muscle.   During her 30 min waiting period after the injection, the patient began to experience throat tightness and wheezy.  She denied sob, cp, facial swelling, tongue swelling.   She reports of above symptoms about 20 minutes after receiving vaccine.    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 abdominal pain, blood pressure abnormality , chest pain, drooling, hypotension, increased swelling, rapid progression of symptoms, respiratory distress, skin changes, tongue swelling and vomiting  .   PMH:  Previous Reactions: allergies including anaphylaxis to shellfish, peanut oil and sulfa drugs. Reaction of arm swelling to location of shot and wheezy when she got the flu shot 7 years ago.    Asthma hx.    She had taken Singulair, cetirizine and albuterol prior to coming. She did not take any benadryl prior to her injection as pt reports that her sister whom is a nurse told her not to take benadryl in case it masks a reaction.      ALLERGY REVIEW OF SYSTEMS:  Patient complains of frequent throat clearing (slightly upon arrival.  with throat itching) and wheezing   Patient denies chills, fever, malaise/fatigue, facial swelling, itching in ears, sore throat, eyes watering, eyes itching, puffy eyes, eye redness, cough, chest tightness, shortness of breath, rash, hives, eczema, cysts, itching of skin, vomiting, abdominal pain, diarrhea, muscle aches, joint pain, dizziness and headaches            Objective    Vitals Vitals:   02/19/21 0933 02/19/21 0944 02/19/21 0952 02/19/21 1002 BP: (!) 143/83 134/81 126/80 123/70 Pulse:         SpO2: 100% 100% 100%              Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is not ill-appearing, toxic-appearing or diaphoretic.     Comments: No facial or lip swelling  HENT:     Mouth/Throat:     Lips: Pink.     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear. Uvula midline. No pharyngeal swelling, oropharyngeal exudate, posterior oropharyngeal erythema or uvula swelling.  Eyes:     General: Lids are normal.     Extraocular Movements: Extraocular movements intact.     Conjunctiva/sclera: Conjunctivae normal.  Neck:     Trachea: Trachea and phonation normal.  Cardiovascular:     Rate and Rhythm: Regular rhythm. Tachycardia present.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.     Comments: Slightly tachycardia (103) Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds and air entry. No stridor, decreased air movement or transmitted upper airway sounds. No decreased breath sounds, wheezing, rhonchi or rales.     Comments: Speaking full sentences.  Musculoskeletal:     Cervical back: Full passive range of motion without pain.  Skin:    General: Skin is warm.     Findings: No rash.     Comments: Injection site w/o erythema or swelling. No adhesive reactions  Neurological:     General: No focal deficit present.     Mental Status: She is alert.  Psychiatric:        Mood and Affect: Mood is anxious ( slightly).        Thought Content: Thought content normal.        Judgment: Judgment normal.      Re-evaluation of lung sounds and throat was done periodically about every 5-10 minutes. No acute findings seen/heard.     Assessment/Plan  Treatment included: albuterol, antihistamines, water and solu-medrol IM and pepcid, albuterol (pt used her own).  Follow up response to treatment: excellent. Scale of 0-10 based on symptoms of tightness was 7 at first. Upon discharge was 3-4/10. Patient discharge: Stable to go home and follow up with PCP and her allergist.  Differential Diagnosis: Anaphylaxis/anxiety (dyspnea, stridor, drooling, tongue swelling)   We discussed close monitoring at home and when/if she were  to take her epi-pen and call 911 if symptoms were to worsen. She's to let her allergist know about her visit today. She may need to have other medications taken prior to her #2 dose of Pfizer according to her allergist recommendations.    Pt appreciative and is ready to go home. Pt wheeled out to front door by security. Accompanied by husband.