Received Jul 17, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| HEPAB | HEP A + HEP B (TWINRIX) | GLAXOSMITHKLINE BIOLOGICALS | 1 | P2443 | IM / LA |
| PNC20 | PNEUMO (PREVNAR20) | PFIZER\WYETH | 1 | LN4930 | IM / LA |
Received the Twinrix and PCV20 in the L arm at last visit. Got her vaccines in the morning and an hour later her L arm started feeling hot/heavy and then right before lunch time started feeling nauseated. Started throwing up that evening. Had chest pain and SOB but this was after the vomiting. Had a fever, felt sweaty, but not sure what temp. Got constipation for three days after. In the ER got IVF and nausea medication. Had to miss 3 days of work. Has never had this type of reaction to vaccines before. Had PPSV23 in 2011 and tolerated well. This was the first time she had had hepatitis A/B that she knows of. Is now 8 days out and chest pain gone, energy mostly better, still nauseated but better than before. Bms back to normal (had gotten constipated from dehydration). Urine is normal. No one was sick at home. Hadn't eaten anything unusual that day. Has now gone back to work on Friday. Repeat lab a few days after discharge showed marked reduction in her LFTs though still mildly abnormal.
day of visit was seen for chronic hip pain, tobacco use. in the prior month had been seen for hip pain, also seen for rash onset after eating sushi the night prior
smoking, chronic hip pain, depression hx, hx of iron and vitamin d
pravastatin, tramadol
wellbutrin
CBC with Diff Collection Time: 07/09/25 10:17 PM Result Value Ref Range WBC 11.04 4.00 - 12.00 K/uL RBC 5.19 4.00 - 5.50 mil/uL Hgb 14.8 12.0 - 16.0 g/dL Hct 43.8 37 - 47 % MCV 84.4 80 - 98 fL MCH 28.5 27 - 33 pg MCHC 33.8 32 - 37 g/dL RDW 12.3 11.5 - 15.0 % Plt 264 150 - 450 K/uL Differential type Automated Abs neuts 9.45 (H) 1.80 - 7.80 K/uL Abs immature grans 0.03 0.00 - 0.07 K/uL Abs lymphs 1.04 0.80 - 3.30 K/uL Abs monos 0.44 0.10 - 1.00 K/uL Abs eos 0.07 0.00 - 0.40 K/uL Abs basos 0.01 0.00 - 0.20 K/uL Neuts 85.6 % Immature grans 0.3 0.0 - 0.9 % Lymphs 9.4 % Monos 4.0 % Eos 0.6 % Basos 0.1 % CMPL POCT Collection Time: 07/09/25 10:22 PM Result Value Ref Range Sodium POC 135 (L) 137 - 145 mmol/L Potassium POC 3.7 3.6 - 5.3 mmol/L Chloride POC 111 (H) 98 - 109 mmol/L CO2 POC 23 18 - 33 mmol/L Calcium POC 10.6 (H) 8.5 - 10.5 mg/dL BUN POC 10 7.0 - 22.0 mg/dL Creatinine POC 0.9 0.5 - 1.0 mg/dL Glucose POC 144 (H) 74 - 106 mg/dL Total Protein POC 8.1 6.4 - 8.2 g/dL Albumin POC 4.0 3.2 - 5.0 g/dL Bilirubin Total POC 0.9 0.2 - 1.6 mg/dL Alk Phos POC 98 42 - 141 U/L ALT/SGPT POC 163 (H) 10 - 47 U/L AST/SGOT POC 185 (H) 11 - 38 U/L CG4 PANEL POC Collection Time: 07/09/25 10:23 PM Result Value Ref Range Lactate (POC) IStat 0.7 0.7 - 2.0 mmol/L TCO2 22 mmol/L pH nonarterial 7.40 7.32 - 7.45 pCO2 nonarterial 34 (L) 40 - 50 mm Hg pO2 nonarterial 55 (H) 37 - 43 mm Hg HCO3 21 21 - 28 mmol/L O2Sat 89 (H) 70 - 76 % IMAGING: XR Chest 1 View - PA or AP Result Date: 7/9/2025 EXAMINATION: XR CHEST 1 VIEW - PA OR AP CLINICAL INDICATION: fever TECHNIQUE: One view COMPARISON: None. FINDINGS: The cardiac silhouette is unremarkable. No sizable pleural effusion. Lungs are grossly clear. There is no pneumothorax. No acute osseous abnormalit is seen in the thoracic cage. IMPRESSION: No acute cardiopulmonary process. Electronically signed by: Navid Zenooz MD 07/09/2025 10:14 PM Treatments: Medications lactated ringers (LR) bolus solution 1,000 mL (0 mL Intravenous End of Infusion 7/9/25 2329) ondansetron (Zofran) 2 mg/mL inj 4 mg (4 mg Intravenous Given $ 7/9/25 2226) ketoROLAC (Toradol) 15 mg/mL inj 15 mg (15 mg Intravenous Given $ 7/9/25 2226)