Age: 16.0
Sex: M
Vaccine: HEP, HEPA, HPV9, IPV, MMR, MNQ, VARCEL
Symptoms: Electrocardiogram normal, Loss of consciousness, Pallor, Posture abnormal, Syncope
Clinical narrative: Supplementary Documentation for Incident at  Center on 8/12/2023 Staff of the day: ? All staff below and RN who was the only nurse who was released early before 2pm as we were staffed sufficiently for the remainder of the day Staff On Site During Incident: ?  RN ?  RN ?  RN ?  RN ? Registration Staff ?      (Registration Staff) ? (Registration Staff) ? (Registration Staff) Witnesses to incident:  ?  (vaccinating nurse of client) ?  (while client fainted a second time) ? Father and Mother of fainting patient, and younger brother of patient Incident: 2:10pm - was vaccinating the client with Hep B, Hep A, MCV4 and MMR vaccine. Upon finished the last vaccine before switching to the Right Deltoid, the client began to faint. He slumped down in the chair and RN called for help. Mother was at patients side and began to yell in panic. Father was in adjoining room with 2nd teenage boy, and came into the room to assist. Staff entered the room to assist RN, and noted he looked pale, but breathing. The client regained consciousness. Water was brought for the client to drink and he started to faint again and lose consciousness. He started to slide out of the chair, but RN and the father held him upright in the chair. Client was instructed to sit on the floor in the hallway adjoining the vaccine room because it was a small room. We wanted to lay him down but he declined saying he was feeling better and wanted to sit. Father stayed seated next to him on the floor. 2:13 ? 911 was called  2:12-2:17pm ? RN was on phone with Paramedics and noted the situation and that the client was currently awake, speaking, pale, and breathing regularly.  2:18pm ? BP: 106/74, HR: 64 RN advises mother that fainting is common after vaccines in teenage children and mother states this has never happened before. RN asks what the most the patient had gotten before and the mother said 2. RN said, he received 4 today, and was supposed to get 3 more. Stated, ?I?m sure he felt nervous? and advised the vaccines were safe, but to wait for the paramedics 2:30pm ? BP: 114/78, HR: 66, O2: 100% Father and other son calm. Mother still showing signs of worry and teary. Comforted by nursing staff and advised to have a seat. Chairs provided for both younger son and mother. Father continued to sit next to client on ground. 2:32pm ? Two Paramedics (male & female) arrive in lot and enter building with gurney. RN updates them and shares vitals. They begin their assessment. RN asked the paramedics to stay for remainder of vaccines, and once assessment was stable. Father agrees, mother disagrees. RN advises parents to wait for paramedics assessment, but that the child needs these vaccines for school and it is better to ?get them over with today?, while the paramedics are here and the patient can lay down in their gurney. 2:38pm ? client says he feels ok and not any nausea 2:39pm ? EKG done. Paramedic says ?looks good? 2:41pm ? BP: 96/63, client standing up with assistance so they can take an orthostatic BP 2:42pm ? Paramedics gather history that client only drank orange juice today, recommend to drink fluids. Client drinking water currently. Paramedics called their on-call doctor and instructed parents that the vaccines were not what caused any issues. That the client fainted and he was safe to received the remainder of the vaccines. 2:46pm ? Client and parents agree to receive rest of vaccines: VZV, IPV & HPV. 2:50pm -doses administered, no complications. Client stable.  Paramedics left and the client and family sat in the lobby for 15 minutes and the record was shared. Client was given an apple juice to drink. Advised by paramedics to call 911 or take to emergency room if any further issues or if they wanted to. Client exited building and team debriefed about incident and next steps: ? Will use this incident for future trainings o Monthly drills to begin ? Brief team next Tuesday ? Need to formalize what emergency bag to grab ? All nurses must have watches with ?seconds? hand before beginning of shift ? Ask for ETA next time from dispatch before hanging up ? Want adult cots to have clients lay down in for vaccines/emergencies. (SAFETY ISSUE) ? Who are we supposed to call and in what order? RN to submit Incident Report and VAERs report to management.