Progress Notes (Nurse Practitioner) ? ? Family Medicine Cosigned by: MD at 5/10/2021 10:30 AM Expand AllCollapse All    COVID VACCINE CLINIC 5/7/2021    Date:  5/7/2021    Subjective Patient is a 39 y.o. female who was seen at COVID Vaccine Clinic today for her second  dose of the COVID 19 vaccination.    She was given the Pfizer vaccination in the right deltoid muscle done in the medical bay due to having anxiety and feeling worked up.  She reported to feeling sad before coming in today as her grandmother passed a week ago (non-covid related), pt was hoping GM would hold on until pt got her 2nd vaccine so she could see her GM.  Pt also has other family things going on that is causing her to feel emotional.    She also was seen in the bay for her vaccine as she has a recent hx to the ED on 05/02/21 for tongue swelling.  She took benadryl prior to her arrival to the ED at that time, symptoms had resolved for her then.     During her 30 minute waiting period after the injection, the patient began to experience cough, throat itchiness, tongue tingling.  She denied difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, 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 , rapid progression of symptoms, respiratory distress, skin changes, tongue swelling and vomiting.    Past Medical History: Diagnosis Date ? ADHD   ? Chronic fatigue   ? Chronic fatigue syndrome   ? Head ache     menstral related ? Hypersomnia, idiopathic   ? IBS (irritable bowel syndrome)   ? Interstitial cystitis   ? MTHFR gene mutation   ? Myofascial pain syndrome   ? PMDD (premenstrual dysphoric disorder)   ? PTSD (post-traumatic stress disorder)   ? Rosacea   ? Sinusitis       ALLERGY REVIEW OF SYSTEMS:  Patient complains of cough   Patient denies chills, fever, malaise/fatigue, facial swelling, frequent throat clearing, chest tightness, shortness of breath, wheezing, vomiting, abdominal pain, muscle aches, joint pain, dizziness and headaches    + throat and tongue itching. :     Previous Reactions:none but see above about ED visit on 05/02/21    Objective    Vitals Vitals:   05/07/21 1140 05/07/21 1151 05/07/21 1206 BP: 137/82 (!) 141/92 127/59 Pulse: (!) 130 (!) 101 99 Resp: (!) 26 20 16 SpO2: 100% 100% 100%          Physical Exam Constitutional:      Appearance: She is obese. She is not diaphoretic.     Comments: Flushed,   HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.     Comments: No tongue swelling noted. Speaking full sentences.  Pt does report cotton mouth. She is able to swallow w/o difficulty.  Eyes:     Extraocular Movements: Extraocular movements intact.     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Regular rhythm. Tachycardia present.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Tachypnea (hyperventilating) present. No respiratory distress.     Breath sounds: No wheezing.     Comments: Clear breath sounds with slight diminished to apex. Improved with albuterol use.  Skin:    General: Skin is warm and dry.  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 is anxious.        Behavior: Behavior normal. Behavior is cooperative.        Thought Content: Thought content normal.        Judgment: Judgment normal.    1158: pt reports improvement of symptoms, "especially after the use of albuterol" but has metallic taste and tongue tingling. Itching has resolved. She feels like she is on the right right of "recovery.".  We went ahead and gave her some zyrtec and pepcid as well. About 5 minutes prior we gave her a minty loungeze which may be contributing to tongue tingling. Lungs cta, no tongue swelling noted, speaking full sentences, hyperventilation-resolved-eupneic, heart rate normal range.  flushing of face improved as well.    Assessment/Plan  Treatment included: albuterol, antihistamines and water Follow up response to treatment: good. Patient discharge: Transported to ED by POV.  Differential Diagnosis: Systemic reaction (headache, itching, tachycardia, hypoglycemia, hypotension, generalized rash)   Stable and improving symptoms. Certainly anxiety may be a factor playing into this but recommended that she seek emergency care for observation and follow up with her primary care along with allergist to look into her two reactions that she has had this week. She declined EMS and wishes to go by pov. Husband here to transport her. VS stable and exam unremarkable. Pt and husband voiced appreciation of care today. ED charge nurse notified of patient's coming.  Dr. updated on pt's visit today.         Electronically Signed 5/7/2021 12:06 PM