Age: 67.0
Sex: F
Vaccine: VARZOS
Symptoms: Vomiting, Yawning
Clinical narrative: November 12, 2018 SHINGRIX 2nd dose Appointment scheduled at 1:00pm; Patient reported to the pharmacy for her 2nd dose of SHINGRIX. She completed the required intake paperwork and took a seat in the waiting area. I reviewed her paperwork and verified the vaccine, lot number and expiration. I took patient into the vaccine room and asked how she was feeling and we discussed possible reactions and then spoke about her family as I prepared her dose. I prepared the right deltoid with an alcohol swab and asked patient to relax. The vaccine was administered intramuscularly into the right deltoid. I inspected the injection site and no redness, rash and bleeding was noted. I covered the area with a bandaid as per my usual process. She pulled her sleeve back down while I began completing the paperwork. Within 20 to 30 seconds patient said she was feeling dizzy. I asked her to remain seated and asked her to take a few deep breaths. I lifted her sleeve of her shirt to inspect the injection site for rash or redness. None was noted.  I stuck my head out the door and asked the pharmacy clerk for a water. Pharmacy clerk returned with a bottle of water and patient took a couple of sips. I checked patient's left deltoid and inspected the injection site. No swelling or rash was present. Her husband, was in the chairs waiting and I asked him to step into the room and told him what was going on. Patient tried to sit up but became more dizzy and was seeing spots. I asked patient to put her head between her knees. Patient did as I asked and began feeling better. Husband asked for me to administer his vaccine while he waited for patient's dizziness to subside. Husband's vaccine was administered without incident. Patient again tried to sit up and became more dizzy. Husband told me that they had left banana bread in the oven and they needed to go home and shut the oven off. Patient wanted to leave with husband, but I asked that she remain with me. Patient began yawning and feeling very sleepy. She laid her head on husband's lap and informed us she just wanted to go to sleep. I attempted to take patient's blood pressure but she was uncooperative and I was unable to get a reading. Patient said she was feeling warm and her skin was wet. I placed the water bottle behind her head and reassured her and had her breath. I again told husband that patient would need to stay with me and he left for home and said he would be right back to get patient. My technician, came over to the injection room at about 1:30pm and asked if everything was ok and I said we were ok but I needed to keep my eye on patient and she should call 911. I checked her injection site again for redness and rash. I examined her face and no swelling was noted but her skin was clammy and her lips were very pale, almost white. She appeared nauseous and I asked if she was going to vomit. She said she didn't think so. I grabbed the garbage can and placed it in front of her. I don't recall exactly but I believe I grabbed the EPIPEN from the emergency box at this time. Patient began vomiting within a couple minutes. The retching and vomiting were pretty severe as I held the garbage and supported her body. I did not notice blood or coffee ground appearance in the emmitus. Initially the emmitus was mostly liquid light brown in color. It progressed to a more solid form. Within just a few minutes patient began gurgling in her throat. I lifted her head to see if she was choking on vomit and if she was breathing. Her face was dark red or almost purple and her head then slumped forward. I held her by the shoulders from in front of her to keep her from falling to the floor. As I was holding her up I stuck my head out the door and yelled for help. Employee immediately came to the injection room I handed him the Epinephrine. Employee took the pen prepared it and administered a dose in her right thigh. Patient came to fairly quickly and then asked why we did that and hurt her leg. I told her she had stopped breathing and we had administered epinephrine. She began crying and shaking and said she felt bad. The Police department arrived and assessed the situation. Within 3 to 5 minutes the paramedics arrived and they took over the treatment. Patient was continuing to shake and cry. Her breathing was pretty shallow and she was very pale. They asked if they could take her to the hospital. Her husband had returned about the same time as the paramedics and he advised they take her to the hospital. Patient's daughter called me about one hour later and asked if she could put me on speaker phone and if I would speak to the doctor at the ER as patient couldn't remember the details of what happened. I relayed these details to the best of my memory and asked if patient was ok. The physician said she was OK and that I did good and she would be all right.