Age: 9.0
Sex: M
Vaccine: COVID19, FLU3, HPV9
Symptoms: Abdominal discomfort, Loss of consciousness, Posture abnormal, Syncope
Clinical narrative: Nurse note from chart on apparent vasovagal syncope s/p vaccine administration: "Pt's caregiver answered the following screening questions negative prior to administration of vaccines:  -Has your child ever had a serious reaction to the flu vaccine in the past? -Has your child ever had a reaction to a Covid-19 vaccine? -Has your child ever been diagnosed with Guillain-Barre syndrome? -Is your child sick today with a moderate to severe illness (e.g., fever)? -Is your child taking Coumadin, Warfarin, or other blood thinners? -Has your child ever passed out or felt faint/lightheaded with injections or blood draws?   Patient well-appearing prior to administration of vaccines though expressing nervousness regarding vaccines. Nurse normalized nervousness (i.e., discussed normalcy of fear of shots) with patient and caregiver and offered patient option to let nurse know when patient felt ready for each vaccine prior to administration of vaccine. Nurse also gave patient option of nurse "counting to 3" prior to administration of each vaccine or not "counting to 3", with patient choosing former option. Nurse also suggested mom hold patient's hand for comfort during vaccines; mom agreed.    Nurse individually administered Covid-19 and flu vaccines in left deltoid IM and HPV vaccine in right deltoid IM at ~0950 with patient sitting on exam table and mom standing next to patient gently holding patient's hands. Within minutes (<2 min) of administration of final vaccine (HPV), with patient still sitting on exam table and mom still standing beside patient, per mom and patient, pt experienced transient loss of postural tone leading to slumping against room wall while sitting on table. Nurse in exam room facing opposite direction sorting AVS papers when initial loss of postural tone occurred; nurse did not directly witness initial loss of tone but heard patient fall or lean back heavily against wall and turned to see patient with lower body sitting and legs hanging off exam table, upper body slouched backwards against wall, b/l eyes open gazing forward, and right arm momentarily extended with fist clenched and then immediately relaxed. No other muscle contraction or convulsions noted. Mom briefly queried patient whether they were being "dramatic" about shots; nurse immediately informed provider who assessed patient within ~3 min of initial loss of postural tone. During this assessment, pt A&Ox4, able to articulate apparent transient LOC ("everything got dark") for a few seconds and spontaneous return to consciousness, and able to add/subtract/multiply by 12.    Per provider verbal instruction, nursing provided water and a cold pack for application to head and observed patient gradually progress through lying, sitting, standing, and then ambulating around exam room over a period of ~30 minutes. Patient also offered goldfish crackers. Mom reported patient did not drink anything prior to visit. Pt with no apparent oral trauma, incontinence or myalgia but did endorse mild abdominal discomfort; nurse asked caregiver if they would like nursing to request medication for abdominal discomfort from provider and caregiver declined. By end of visit (~35 min s/p syncopal event), patient with normal symmetrical tone and strength, able to stand and ambulate comfortably independently around exam room. Nurse provided education on provider's primary DDx - vasovagal syncope - including pathophysiology of condition, clinical presentation and management, and prevention, and caregiver verbalized understanding and familiarity with condition. Pt and caregiver provided RTC precautions. Nursing escorted pt and caregiver to vehicle, with patient independently ambulating comfortably."