Epinephrine/Anaphylaxis Reports

CDE Health and Wellness / Report of Epinephrine Administration (2014-15)

Respiratory Symptoms
(check all that apply):
 Respiratory
Cough
Difficulty breathing
Hoarse voice
Nasal congestion/runny nose
Swollen throat/and or tongue
Shortness of breath
Itching - mouth/throat
Tightness - chest/throat
Wheezing
GI Symptoms
(check all that apply):
 GI
Abdominal discomfort
Diarrhea
Difficulty swallowing
Nausea
Vomiting
Skin Symptoms
(check all that apply):
 Skin
Flushing
General itching
General rash
Hives
Lip Swelling
Localized rash
Pale
Cardiovascular Symptoms
(check all that apply):
 Cardiovascular
Chest discomfort
Bluish skin
Dizziness
Weak pulse
Headache
Heart racing
Other Symptoms
(check all that apply):
 Other
Sweating
Irritability
Loss of consciousness
Metallic taste
Red eyes
Sneezing

Disposition:

Time elapsed between
communication of
symptoms and
administration of
epinephrine
 HoursMinutes
Time

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