bilateral hand numbness/tingling; tremors. Pt. is a 47 y.o. male who presents regarding a potential concern for an adverse reaction to the COVID-19 vaccine.    First Dose in Series:  Vaccine was obtained from the following clinic/location: on the date of: 4/8/21 and approximate time of 1 - 2 afternoon  Vaccine was administered to patient's: Left Deltoid Vaccine manufacture was: Pfizer No Previous Reactions to other immunizations   Known COVID Exposure since receiving vaccination?: No Had covid in October - 1st of nov  Patient notes the following symptoms  Modifying Factors or additional details:   symptoms started after the covid vaccine which I received 4/8/21 I guess I initially  thought it was from the workout program I was doing but as the inflammation continued to spread after discontinuing my workout  Patient is a 47-year-old male presenting with concerns for possibly adverse reaction to COVID-19 vaccine.  He received vaccine on 04/08.  He reports approximately 6 weeks ago he started to notice tingling and tremors in his hands.  He reports that he was recently seen by a provider who sent him to an orthopedic surgeon.  He reports that he did receive cortisone injections which seemed to help his trembling and discomfort.  He reports that he also did a short course of steroids.  He is unsure if that was helpful or not.  He reports that he has been taking Aleve.  At this time is trim tremors happen at random times.    At this time it is hard to determine the cause of his tremors due to virtual apt.  .  Patient does have an EMS scheduled and is being followed up by Orthopedics.  Will also refer to neurology for further evaluation.  Will try a short course of steroids to help with inflammation as this seemed to help last time.  Discussed potentially doing physical therapy to help manage his symptoms and increase strength .  At this time patient does not want to do physical therapy.  Encouraged him to discuss with his primary care doctor in the future.  Encouraged him to follow-up with orthopedics and his primary care doctor for further evaluation.   08/01/21: He state she is having tremors in his upper body . He states they are worse than they have been lately. He states that he has been having symptoms since he got his vaccine in April. He states he is set to see a neurologist next week. He states he has been having the shaking/tremors for over one  Minute straight.  ED COURSE / MEDICAL DECISION MAKING / TREATMENT PLAN:  Patient arrived via private vehicle with a chief complaint of tremor. Patient was seen and examined by myself and the attending physician in the emergency department. The patients vitals were obtained and pt was stable. Patient presents to the emergency department for 4-day onset of worsening tremor in the bilateral hands and an intermittent "electrical wave" sensation that passes over him. The patient states that all of his symptoms seem to have started after getting his 1st dose of the Pfizer COVID-19 vaccine in April. The patient states that immediately after receiving the vaccine he developed significant inflammation in his left arm and he became stiff and hard to move. Patient states that then he noticed his right arm started experiencing significant inflammation as well. The patient states he would get intermittent episodes of numbness and tingling radiating down both arms but then in the last month has developed a restlessness in his hands bilaterally. Patient states that he has had cortisone shots in both arms with some improvement in his inflammation. The patient states that his primary care provider gave him a burst of prednisone without improvement of his symptoms. Patient states that his PCP told him to follow-up with neurology but he has not been able to get into see an appointment yet. On physical exam the patient has a restless rolling of his wrists and fingers bilaterally. On neurologic exam the patient has intact sensation bilaterally, normal finger-to-nose testing bilaterally, is able to perform rapidly alternating movements bilaterally without difficulty. Patient has intact strength in the bilateral upper extremities. An IV was established and labs were drawn. Patient's lab work was unremarkable.on reassessment the patient states that he came to the emergency department because his wife is concerned that he is developing Guillain-Barré syndrome from the COVID-19 vaccine. The results were discussed with the patient, questions were answered, and he expressed verbal understanding and agreement with the plan.