Progress Notes APRN (Nurse Practitioner) ? ? Family Medicine Cosign Needed Expand AllCollapse All    COVID VACCINE CLINIC  3/24/2021     Date:  3/24/2021                                                                                              Subjective  is a 70 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.   During her 15 minute waiting period after the injection, the patient began to experience a change in her cough and felt nauseated. She felt better shortly after 5 minutes but then her husband noted some redness in skin color in her legs and on her abdomen.  She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, 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 , chest pain, collapse, hypotension, rapid progression of symptoms, respiratory distress, skin changes and increased in HR.   Upon arrival to bay, HR 180-190. Pt's husband states pt with hx of svt. Usually in high 200's or low 300's if it comes on. Hx of having HR in the 150s at times. Usually resolves on its own with elevation of feet above pt's head per pt's husband.  He is not worried about it but wanted to know what her pressures were doing.     PT with alz. Pt's husband is main caregiver.      ALLERGY REVIEW OF SYSTEMS:   Redness went away after sitting down.: CONT negative HENT negative Eyes negative Respiratory negative Skin negative GI negative Neuro negative     Previous Reactions: none    Objective    Vitals Vitals:   03/24/21 1045 03/24/21 1101 03/24/21 1115 BP: (!) 141/86 124/80 124/82 Pulse: (!) 180 (!) 158 (!) 150 SpO2: 100% 100% 100%        Physical Exam Constitutional:      General: She is not in acute distress.    Appearance: She is well-developed.     Comments: Flushed appearance upon arrival to bay.   HENT:     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  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.     Heart sounds: Normal heart sounds.     Comments: HR came down to 150-160's after Trendelenburg position. Ice pack placed on chest.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds. No wheezing.  Skin:    General: Skin is warm and dry.  Neurological:     General: No focal deficit present.     Mental Status: She is alert. Mental status is at baseline. She is disoriented.     Gait: Gait normal.     Comments: Disoriented at baseline per pt's husband. Pt able to tell me who her husband is and their plans for cruise this summer.   Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.         Assessment/Plan  Treatment included: water and Trendelenburg position Follow up response to treatment: fair. Patient discharge: AMA.  Differential Diagnosis: Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns)   Discussed pt's HR despite of pt being stable here that they ought to seek further medical care in the ED. Pt husband declines as "she's done this before and I'm not worried.  We will go to the hospital if she is not getting better.  I think when we get home, in her normal environment, she will be fine."  He voices appreciation for our evaluation and concerns. She was able to demonstrate assistance to standing position without reports of feeling dizzy or lightheaded. Pt color does look better. Redness is gone and she continues to report to feel well.  Pt wheeled out in wheelchair.  Husband is aware of our recommendations.     APRN Electronically Signed 3/24/2021 10:59 AM       Division of Health