Age: 25.0
Sex: F
Vaccine: HPV4
Symptoms: Syncope, Tonic clonic movements, Urinary incontinence, Vomiting
Clinical narrative: 11:00 am Patient is a 25 yr old female is in the nurse clinic today for immunization for HPV (Gardasil). Patient is alert and oriented x 3. BP 121/70 | Pulse 70 | Temp(Src) 98.6 °F (37 °C) (Oral) | Resp 17 | Ht 5' 6.54" (1.69 m) | Wt 149 lb 4.8 oz (67.722 kg) | BMI 23.71 kg/m2 | LMP 02/19/2014. Identified patient with name and DOB. Patient given HPV VIS sheet to review (5-17-13). Advised patient on any potential reactions to vaccine. Patient has no known history of drug or food reactions or allergies. Pt confirmed no allergies before HPV was administered. Patient states that she history of fainting after vaccines. Placed pt in recliner with feet elevated. Given some water to drink. After informed consent. Administerd the HPV vaccine to the left deltoid IM. Patient reported she felt fine right after vaccine. Call bell in reach, pt aware. Seven minutes post vaccine patient c/o to Nurse not feeling well. RN in room calling for assistance. MD was immediately called to pt bedside. Patient had syncope with seizure like activity with tonic clonic movements x 4 episodes. Patient was sweating profusely. Nurses x 4 in room. IV was started by RN #22 g to the right AC. Normal saline bolus was hung. Patient placed on cardiac monitor by RN. Vitals obtained. Patient was placed on non re breather oxygen mask at 15 LPM. Patient is able to respond to MD. Oriented x 3. Able to answer questions and follow commands. Patient responding to treatment reports feeling "very drowsy". Glucose obtained by RN @ 114. MD in room with nurses. 11:25 am Patient still diaphoretic requested to go to bathroom. Up to restroom with assist of nurses x 2. BP 105/64 | Pulse 61 | Temp(Src) 98.6 °F (37 °C) (Oral) | Resp 14 | Ht 5' 6.54" (1.69 m) | Wt 149 lb 4.8 oz (67.722 kg) | BMI 23.71 kg/m2 | SpO2 100% | LMP 02/19/2014. Patient able to slowly ambulate to use restroom. Patient reports that she urinated herself. Incontinence episode. MD made aware. She will speak with neurologist.  Per neurologist vaso vagal or syncope reactions to vaccines can results in seizure like movement and activity. Keep pt in clinic x 1 hour to monitor. Patient has call bell in reach and continuous fluids, monitor and pulse ox. 12:15 pm Patient get more pink skin color back. Report some relief but has some nausea. Fluids infusing well on pump. Pt is tolerating. Heart rate on monitor @ 55 BP 96/55 RR 16 Sat 100%. Changed pt to 2L nasal cannula per MD request. Advised pt that she had a severe adverse reaction the vaccine. We will report the reaction to VAERS. Added to patient allergy list. 12:25 pm Pt ringing call bell. Reports severe nausea. Emesis basin given to patient. Vomiting episodes x 3. Patient reports she feels some relief after vomiting. MD made aware pt needs to go for further eval. Patient husband now to FC via metro and taxi. Per order of MD give 4 mg Zofran IV push. To administer now. Patient is a 25 yr old female needs ambulance transport to another facility. Lifecare called at 1228. Dx at time of transfer: vaccine reaction/ syncope. ETA of lifecare ambulance 30-60 minutes. Patient now reports "feeling much better". No nausea at all. Refuses Zofran at this time. MD in room now. Patient looks much better. Vitals obtained BP 114/67 | Pulse 77 | Temp(Src) 98.6 °F (37 °C) (Oral) | Resp 16 | Ht 5' 6.54" (1.69 m) | Wt 149 lb 4.8 oz (67.722 kg) | BMI 23.71 kg/m2 | SpO2 100% | LMP 02/19/2014 HR back up RR WNL Pulse OX WNL BP is better @ 114/67. Continue to monitor. Pt request to go home when husband arrives. Advised to go home and rest and drink plenty of fluids. Ok per MD to send pt home when done with fluids and husband is here to pick her up. Patient recovered and was released ambulatory with husband from the nurse clinic at 1330. Discharge.