Age: 13.0
Sex: M
Vaccine: HPV9, MNQ, TDAP
Symptoms: Pallor
Clinical narrative: Pt had an immunization appointment scheduled for 1:45pm. Patient received Tdap (2CA61C1), MCV4 (U7939AA), HPV (1965079) at 1:54pm. Patient flinched on his final vaccination (HPV). Staff asked him if he was okay. Patient stated he was okay and got up from his seat and picked out a sucker out of the basket. Patient left the room with his mother and brother present. Patient?s color in his face was normal when he was exiting the room. Staff called Exam Room 1?s phone at 2:00pm stating ?We need a nurse out here.? Staff exited exam room one and went into the waiting room. The patient was laying on his back with his mom holding his head. Patient was awake, pale in color, and slightly disoriented. Staff instructed the mother to let his head lay back on the floor and propped the patient?s legs up on a chair. It was difficult to move the chairs around due to the excess of chairs in the waiting room. I brought an ice pack and placed it on the back of the patient?s neck. I asked the patient if he felt like he was going to get sick. The patient stated he did feel like he was going to get sick, so I grabbed a trashcan. Staff then got him a water to sip on. Staff also gave the patient a sucker to boost his blood sugar. The patient stated that he hit his head when he fell. I asked the patient to point to the part of his head that hurt. The patient pointed to the upper back part of his head. I checked the patient?s head and did not observe any redness, cuts, or bumps on his head. At this point, the patient had been lying down with his feet propped up on a chair for about 7 minutes. The patient stated that he was feeling much better. Staff and I helped the patient lower his legs to the floor and had him lay there for another 2-3 minutes with the icepack still on his neck. Staff encouraged the patient to keep taking sips of water and got the patient fruit snacks to eat. We sat the patient up into a sitting position, and the patient stated he felt fine and did not feel dizzy or sick feeling and did not have double vision. Staff checked the patient?s pupils, and they were equal, round, and reactive. I told the patient?s mom that it is very normal for children to faint after they have received a shot. I also let her know that for his next appointment, we will vaccinate him while he is laying down and have an ice pack already applied to his neck prior to the vaccinations. I also informed mom that pt. should eat something before he comes to his appointment. I told mom to keep an eye on his head and that she could take him to a doctor to get checked out if she felt that he needed it. The patient stated that his head was hurting a little and staff told the patient?s mother that if his head still hurts tomorrow, she should give their doctor a call. Mom asked if the patient was able to attend football practice tonight. I asked mom if there was any contact at the practice today and she stated there was not. I told mom that pt. can go to practice tonight if he is feeling okay to do so. Staff then sat the patient in a chair in the waiting room for 2-3 minutes with the icepack still on his neck. The patient?s mom went to check him out and I told staff to book his next appointment out for 30 minutes instead of 15. The patient then was ready to stand up, and was walking around without any dizziness, nausea, vomiting, and double vision. I stood with the patient while his mom was still checking out. Once his mom was done checking out, I walked the patient to the car.