Age: 17.0
Sex: M
Vaccine: MENB, MNQ
Symptoms: Computerised tomogram normal, Epistaxis, Face injury, Fall, Fatigue
Clinical narrative: Patient received two vaccines this morning. He was seated in our lab chair at the center of the room. RN administered the MenQuadFI in the Left Deltoid and the Bexsero in the Right Deltoid at approximately 10:00am while patient was seated. Patient stated he did not like needles however he said he had never fainted or had a seizure, mother of patient confirmed that he has never had a reaction. I stood next to the patient after administration until approximately 10:15am when I walked to the door of the lab to show him the way out. During the window of 10:00-10:15 patient was alert, skin was pink, and he was talking and even laughing and making jokes. When the patient stood to folo me out, he fell face first on the ground. His face did make contact with the ground. He did not brace himself in any way. With the help of RN, we immediately turned the patient on his side as a seizure precaution and when we did he immediately opened his eyes and looked at me. He then asked "What happened?" There was no seizure like activity so we sat him up slowly to a sitting position. I got ice packs and we placed them on the back of his neck and chest and had him smell a few alcohol swabs. Patient did have a pale color at this time. I checked his pupil reactivity and it was normal. I began to talk with patient and he was able to tell me his name, date of birth, where he was, and todays date. Patient complained of his front right tooth hurting and his lip and nose were bleeding. There was swelling of his lip as well as some swelling of his chin and forehead. His mother sat on the floor behind him and let him lay on her chest for several minutes. RN obtained a fan and sat it to blow on him. I got him something to drink. After laying with his mother for about 5 mins he stated he was okay but tired. We gave him a wet napkin to hold on his bleeding lip and cleaned up his nose that had stopped bleeding. Patient's mother requested we call EMS. EMS arrived between 5-10 minutes after that. EMS reevaluated patient's consciousness and contusion. EMS advised patient's mother that it would be her decision if she wanted follow up care. Patient's mother decided to take pt. to ER herself. I assisted patient into a wheelchair obtained by RN and we got patient to the mother's car with no problem, patient stood with assistance out of wheelchair and into the front passenger seat of his mothers car.    At approximately 3:45pm RN called patient's mother to check on pt.'s status. Mother reported that patient was "back to normal and doing great" since returning home from the hospital. Mother reports his head CT was clear, there were no signs of concussion, and no signs of seizure activity. The physician in the ER did recommend 1 to 2 stitches for his contusion on his top lip. However, mother reported that pt. asked the physician if that would involve any kind of needle or injection. When the physician replied that it would and explained the procedure, mom reported pt. turned white and went limp again so they declined suturing. He returned to "normal" after declining the procedure and was released home. Mother reports patient is taking ibuprofen for swelling and pain and no other issues have occurred since being at home.