Age: 13.0
Sex: M
Vaccine: FLU4, HPV9
Symptoms: Presyncope, Respiratory rate increased, Screaming, Speech disorder, Wheezing
Clinical narrative: Per order of N.P. Pt to receive HPV #2 and Flu vaccine today.  When pt was approached to receive the same,he stated, "Wait, can I go to the bathroom first?"  Pt went to bathroom to void.  Upon returning to exam room, pt stated, "I don't want any shots.  I'm scared.  I don't like shots."  Reassurance given to pt.  Offered this pt to have his dad present now, because initially he did not want dad present.  Pt states, "Yes.  Can you get my dad?"  Summoned pt's dad.  He presented into exam room and told pt to relax.  Dad informed me that pt 'gets worked up' prior to any experience that he does not want to do.  Dad states, "He even gets this way when his mother reprimands him.  He gets all worked up and like a panic attack.  He breathes fast and everything."  Reassurance given.  Dad held pt so that he could safely receive his Flu and HPV #2 vaccine.  Flu vaccine was given as ordered in right deltoid.  Pt let out a scream and said, "Ow.  That hurts me.  It's burning!"  At this point, pt's sister had entered the room and told pt to relax and settle down.  Pt began to use foul language and his sister told him that his language was inappropriate.  Dad was still holding pt and pt told him that his right arm was now ok.  Dad then informed pt that he would now get his second vaccine and then they would go home.  Pt began to cry and said that he didn't want any more shots.  Dad said to pt, "You're a big boy and you're getting just one more shot.  Don't be a baby."  Dad then informed me that he had a good hold on this pt and that I could go ahead and give the HPV vaccine.  Informed dad that pt would need to sit after receiving his HPV vaccine to assess for any side effects.  Dad stated compliancy regarding the same.  At 1615 HPV vaccine was given into pt's left deltoid area.  Pt again let out an outburst of crying.  Pt then states, "I can't breathe.  I can't breathe."  pt had a near syncopal episode.  Pt did not have any loss of consciousness.   VS:  110/76-86-26.  O2 sat 100 %.  I then assisted this pt with slowing down his breathing.  Pt was somewhat compliant and diaphoretic at this time.  Cool cloth applied to pt's forehead and neck area. RN was then in to see pt.  She attempted to give pt O2 via mask. N.P. presented and assessed pt's O2 sat still at 100%.  She stated that O2 not necessary at this time.  Pt was not responding well at this time.  Positioned pt in left side lying position.  110/80-84-24  O2 sat 100%. Per N.P., RN placed Ammonia Salts Ampule under pt's nose.  Pt immediately sat up and was combative, stating, "What happened?"  Reassurance given to pt and his dad. Informed pt that he had a near syncopal episode. M.D. In to see pt.  She heard wheezing throughout all lung fields of this pt.  Per order of M.D. Albuterol Neb was given at 1625 to pt.120/66-84-22 O2 sat 100%.  At 1633, pt was reassessed by M.D. No audible wheeze was present per M.D. At 1645:  110/60-83-20 O2 sat 100%.  Pt resting in room.  Pt then sat up and stated that he was feeling better.  Pt was alert and oriented to time, place, person and situation.  Pt told me and his dad, "I'm better now.  I want to go home."  Reassurance given to pt.  Told pt that he would be reassessed in 15" and then N.P. would determine if pt were able to go home.  At 1700, pt was breathing well with good respiratory rate.  Lung sounds clear to auscultation.  Coloring good.  Skin warm and dry.  110/60-80-18 O2 sat 100%.  Pt was then reassessed by N.P. And was then released home by the same.  Pt stood on the floor, holding his dad's hand.  Pt denied any lightheadedness or vertigo.  Pt states, "I'm just tired."  Pt was alert and oriented to time, place, person and situation.  Pt's gait was slow, but steady.  Pt ambulated to his dad's car, with the assist of his dad and his sister.