Age: 33.0
Sex: F
Vaccine: HEPA, SMALLMNK
Symptoms: Pharyngeal swelling, Pulse abnormal, Vision blurred
Clinical narrative: On 6/15/24, at Event, we had an incident with a 33 year-old female (PEH) w/ a medical history of hypertension and asthma,  and allergy to Demerol.   Pt was being registered and pt seemed to be nodding off but was still able to answer all the registration and screening questions, but she seemed to be distracted and unfocused, with delayed verbal responses.  Registration staff had to ask screening questions several times because the pt kept ?nodding off.? Registration staff told pt to go over to the vaccination area and then she walked past the table and came back to the registration staff to ask where the vaccine table was at.    Once she arrived at the vaccine table, she seemed normal but slow (I.e. delayed verbal responses).  Pt was vaccinated with Hep A and MPOX around 1600.  Shortly after vaccination, pt started to complain that she felt nauseous.  Nurse team brought her water and an ice pack since it was a hot day today and we were outdoors.  Pt stated she drank some alcohol but answered "No" when I asked if she used drugs.  We reassessed her at 1610 and pt was still complaining of nausea and that she ?didn?t feel good.?  We checked her pulse, which was high at 102 bpm, so we decided to check her BP as well.  At 1615 her vitals were pulse 88 bpm, O2sat 98%, BP was difficult to obtain, but systolic was around 140 mmHg.  Shortly after, Pt started to come in and out of consciousness, pt was not responding to our questions and when she did, she had slurred speech. pt was having blurry vision, pt was catatonic, pt skin was clammy, and her pulse was weak. Nurse team and I agreed to administer epinephrine due to her signs and symptoms occurring shortly after the vaccines.  We administered adult epinephrine to pt at 1623.  Pt became conscious after epinephrine was given, but still stated she ?doesn?t feel good.?    Shortly after, an Event Medic came by and used an automatic BP cuff to check pt?s BP.  At 1634, pt?s pulse was 88 bpm O2 sat 96%, and BP 138/80.  We reassessed five minutes later and at 1639, pt?s HR was 88 bpm, O2 sat 100%, and BP 137/81.   She then complained of chest pain and was pressing her fingers to the left side of her chest.  Pt stated her pain was 8/10.  Patient also complained of swelling of the throat and ears. Patient is still able to verbalize with no wheezing or difficulty breathing. The fire department came by and began asking the pt assessment questions.  Fire department asked pt about the chest pain, and pt stated 8/10.  He then asked if pt had numbness and tingling on the left arm, and pt said yes.  Pt stated she wanted to go to the hospital as we were waiting for EMS to arrive.  We continued to provide support to the patient and reassessed her every couple minutes.  About 10 minutes later, patient states that she feels better and her pain is ?not that bad? at the time.  Pt stated she did not want to go to the hospital anymore, but we recommended that she still wait for EMS to do an EKG to assess her heart, which pt agreed to.  A couple minutes later, pt stated she started feeling nauseous again.  I started making small conversation with her and she would respond, but she felt like throwing up every time I asked her questions.  Paramedics finally arrive around 1700-1715.  We briefed the paramedics and the pt was being transported to Hospital by 1725.