Age: 13.0
Sex: F
Vaccine: HEP, IPV, VARCEL
Symptoms: Dizziness, Dystonia, Limb discomfort, Loss of consciousness, Muscle spasms
Clinical narrative: Pediatric Engerix-B, Varivax and IPOL vaccines administered at 8:45 am. The patient reported feeling dizzy after receiving third vaccination (IPOL). At time of vaccinations patient was sitting in a chair, however noted patient becoming pale, and stating ?I am feeling dizzy.? Mother was holding onto the patient and reported ?She is becoming heavy.? Wheelchair requested to transport patient to the exam table in the room next door, however patient could not hold herself up independently anymore and was assisted gently to the floor to prevent any falls/injuries. After assisting the patient on the floor, patient lost consciousness. This nurse placed wet cold towels on patients face and a cold back to the back of her neck. Patient regained consciousness approximately after 4 seconds, and began stating "My arms are feeling heavy, and they are cramping." Noted patient clenching both fists, upon further assessment hands cold to touch and bilateral nail beds pale.  Patient was immediately assessed by the nurse, patient is observed to be pale, however conscious and has her eyes open. Hands continue to be clenched, cold and nail beds pale. Vital signs checked at 8:56am - Blood Pressure right arm lying 121/69 mmHg; Pulse 95 bpm; Respirations 28. Patient is alert and oriented to name and place, in no respiratory distress, denies any dizziness. Continues to report cramping of both hands. Physician on site was notified immediately for further assessment. MD further evaluated the client, per MD no visual or palpable injuries observed to any parts of her body at this time. Mother reported that daughters last full meal was yesterday evening, and this morning she just had half of an apple. Repeat Vital signs at 9:00am   Blood Pressure right arm lying 119/84 mmHg; Pulse 106 bpm.  Provider advised to give Ensure (nutrition shake) to the patient. After a few sips of Ensure patient began to report she was feeling better. 9:05 am Repeat Vital Signs: Blood Pressure right arm lying 118/71 mmHg; Pulse 85 bpm; Pulse oximeter 100%.  Continued to observe client, mother reported that this is the first time that her daughter has had this kind of reaction after a vaccination.  Patient reported feeling much better and no longer reporting arms feeling heavy or cramping to her hands. Patient assisted to the chair, sitting upright. At 9:12am Vital signs re-checked Blood pressure right arm sitting 127/68 mmHg; Pulse 87 bpm; Respirations 18; Oxygen via pulse oximeter 100%. After 30 minutes, client is observed to regain her normal color, talking more and is alert and oriented to name, time, and place, denies any headache, nausea, or dizziness. Nurse re-assessed no visual or palpable injuries noted at this time. On-site physician advised mother to continue to observe the child for any dizziness, headache, nausea, altered mental status, or sleepiness. If any of these occur to call EMS or take the child to the nearest Emergency Room as soon as possible. Client is ambulatory with a steady gait, discharged to home at 9:40am, accompanied by mother.