52 yo Female had symptoms of anxiety ( tachycardia, racing thoughts about vaccine) and hyperventilation syndrome ( tachypnea, paresthesia or tingling sensation on her fingers ) 14 minutes after receiving her 1st IM dose of Pfizer.COVID 19 vaccine.  She has no prior history of anaphylaxis but had adverse reaction to acetaminophen years ago when she felt nauseated , with tingling sensation of fingers but no associated angioedema or low blood pressure , no prior treatment with Epipen IM.  She occasionally have similar symptoms at home after work but milder as per her husband .   Other risk factors : she missed breakfast and did not bring food for lunch , or snack, took only coffee few hours before vaccine . She is taking medications for her menopause symptoms which she did not take today.   She received her 1st Pfizer IM  dose at 12:15 PM and 14 minutes later called the attention of the EMT and physician at vaccine clinic  that she had  stomach discomfort, felt nauseated , cold , with palpitations , followed by tingling sensations of her fingers.  She had no difficulty breathing or swelling of her throat, no hoarseness.  She denied  lip  swelling and throat tightness. She admitted she had racing  thoughts in her head.  She was at observation area and immediately moved to the close observation area via wheelchair. She continued to be alert and oriented, appeared pink , no near syncope but was breathing fast ( 20-22/min) with sigh breaths.   Initial vital signs showed stage 2 hypertension , 160/100mmHg ( MAnual BP) , HR 101/min,  SpO2 98 to 100% on room air, RR20-22/min.  She was afebrile.   Serial exams were done.  She remained  alert, oriented to place and person , clear vision, though felt ? dizzy? in the beginning, but improved after she was allowed to drink 1Tsp. of caramel syrup with water and ate a fig bar at 12:40 pm. She No focal weakness or deficits, but her distal fingers felt cold with paresthesia . HEENT: tongue appeared normal with Mallampati score 2. She did not develop stridor or hoarseness throughout observation.   VS  were repeated every 10 minutes , BP ranged from 140/ 80mmHg and later improved to 120-130/80 mmHg, SpO2 98% to 100%on room air, RR initially tachypneic 20-22/min but after she ate , drank water  and reassured  that her vital signs were improving , no strider , clear lungs to auscultation, RR improved to 16 to 18/min and HR in 70?s per min.  She was accompanied by female vaccine staff to the restroom to urinate, no incident thereafter and she and her husband verbalized she was feeling better  . Upon discharge home , she had resolved dizziness, resolving finger paresthesia , resolved sensation of coldness  when given a foil wrap and a shawl, On exam , remained alert and oriented , HEENT exam without oral-mucosal swelling , no facial angioedema, verbalized chest tightness resolved after knowing he lungs were clear to auscultation.   She did not develop stridor , appeared comfortable , with clear speech .  She did not develop angioedema and and no hives.  Tongue exam normal without angioedema. Eye exam normal.  Chest  clear breath sounds to auscultation, no wheeze, Heart Improved normal resting HR (70?s/min) , no murmur , good and equal radial pulses.  Distal Upper extremities perfusion normal , were warmer  to touch ( was cold initially )  , pink, and well perfused. Nausea and epigastric  pain resolved , She  was kept under close observation until full recovery. Since she did not have signs of anaphylaxis , thus she was not given  epipen auto injection.  She did not  develop stridor, no throat tightness ; her tachycardia resolved and her BP gradually improved to 130/80 mmHg) with rest and sustained improvement until time of discharge home with her husband . Approximate duration of observation was 80 minutes.  They were initially offered to go to urgent care if they elected to be observed elsewhere but they decided to stay behind until she felt improved and reassured that her exam and VS were improving.  She was  able to stand up, observed to have normal gait , was escorted to her car with no further incident.  She and her husband verbally agreed to have her condition reported to VAERS. They were advised to read and follow advise of Pfizer EUA handouts.  If her symptoms worse. ( difficulty breathing, chest tightness , pallor , dizziness , to call 911 and bring to nearest ER. They were also asked to follow up with their primary care provider to consider options available for the second COVID 19 vaccine and monitor her BP and symptoms suggestive of anxiety.  Follow phone call done, she did well after going home but the next day , more than 24 hours after vaccine was given , she felt chest tightness , was brought by her husband to Medical Center , patient verbalize her sus BP was 174 and DBP mid 90?s.  She did not recall any injected medication , was observed and sent home with symptom improvement .  Upon phone follow today, 5/25, she verbalized she is feeling better and resting at home.  She acknowledged high BP as describe as above but asymptomatic now.  She will follow up with her primary care physician on 5/26/2021.