Age: 28.0
Sex: M
Vaccine: COVID19, FLU3
Symptoms: Pupil fixed, Respiratory rate increased
Clinical narrative: Prior to administering the vaccinations, patient confirmed that he had a history of syncope, and had fainted after receiving his first Covid-19 vaccine. He reported this as being three years ago. patient agreed to stay under observation after his injections, as a precaution. After completing the second injection (fluarix), patient stated, "I feel like I'm going to pass out" and endorsed feelings of lightheadedness and flushing of the skin. patient became tense at that point, and fixed his gaze on the opposite side of the room, while assuming a bracing-type posture that consisted of rigid arms and back with hands grasping the proximal knee bilaterally. His breathing increased in rate, which was not assessed by the RN who chose to guide the patient through breathing techniques to relax the patient, who was showing increasing signs of tension. After 15 seconds of this, the patient stopped breathing, and began to slump forward in the chair, where he was braced by the RN to avoid falling out of the chair. At this time, the patient's head and neck extended suddenly, and the rest of his body posture also changed. Patient's eyes were fixed and dilated, his legs and body were also rigid, and his hip extension put him at risk of sliding out of the chair. The patient's right arm presented in a decerebrate posture, rigid with full extension, and external rotation of the closed right hand. The left appeared more decorticate, as it was flexed across the abdomen with the left hand also flexed. patient showed signs of diaphoresis along the anterior hairline, without extension to the rest of the forehead at that time. His mouth was open, and no respirations were noted during this time, though there seemed to be slow, rhythmic movements in his shoulders, head, and neck. This rigid period lasted no more than 20 seconds, and the patient was appropriately responding to questions before the rigidity waned. Patient was able to sit up, fully upright, under his own power. He was A&OX4 at this time. He was diaphoretic globally, with damp spots visible in his shirt, and pooling on the back of his hands. Respirations returned to a normal rate and rhythm, and patient denied shortness of breath, chest pain, or any other discomfort, aside from the diaphoresis. Patient also denied being assessed for epilepsy in the past. The RN provided emotional support to patient while assessing for symptom return and reduction. After 5 minutes of conversing and assessing, patient stated, "I'm starting to feel like I'm going to pass out again." Breathing exercises were employed, again, and patient did not proceed to the rigid state that he had previously. Total time for this was 2 minutes. Patient provided the name of his Clinic provider, and his Clinic record number, to allow the RN to give report to his primary care team. After 20 minutes total time, from initial onset to release, patient stated a desire to go home. The RN offered for patient to remain longer to watch for a possible third spell, and that offer was refused. The RN escorted patient to the front of the store, where he restated that he felt comfortable going home. Report was given to a Clinic Nurse Line RN, along with the writer's phone number - if follow-up was desired by the patient's primary care team.