Age: 57.0
Sex: F
Vaccine: HEPA
Symptoms: Dyspnoea, Eye haemorrhage, Eye pain, Fatigue, Feeling cold
Clinical narrative: The patient said she needed her second Havirx. She reported no adverse reactions with previous vaccines. I administered the vaccine with no incident and asked the patient to stay in the store. She and her husband said they were going to shop and she felt fine. She went to the restroom and returned several minutes later stating her eyes hurt and she felt tired. She specifically said no to dizziness, headache, and feeling feint. She pointed out she had a burst blood vessel in the outer aspect of her left eye. I had not noticed the redness in her eye when I gave her the vaccine and she said she had not noticed it earlier in the day. I told her eye pain was not a typical adverse reaction to a vaccine, but I wanted her to sit down and stay with me for observation. She agreed to sit down and I had my technician get her an ice pack to hold on her eyes. I did not notice any swelling or redness to her skin anywhere on her body.  Her husband told me to go back into the pharmacy because they didn't need me to sit with them. I stood at the terminal that allowed me a full view of the patient and prepared the documentation and cart in the event that her symptoms worsened. I was not comfortable being that far from her, so I went back out to sit with her and to take her blood pressure. Her husband chose to leave and put stuff in their car. I told her she needed to tell me if she had any sinus congestion or feelings of shortness of breath or chest pressure.  She is not on medication and has no history of high blood pressure, but her pressure was 164/100 with a pulse of 65. I explained my options for medication to help with an allergic reaction, but she wasn't exhibiting anything that the medications would treat. I told her I would like to give her a dose of diphenhydramine just as a precaution, but she refused both treatments. Her reasoning was she might be having a reaction to the shot and she didn't know how she would react to the medications I was offering.  I asked if she wanted me to call 911 because she was not feeling any better. She and her husband both said no. When she said she was starting to feel short of breath, I told my technician to call 911 and I strongly encouraged a dose of diphenhydramine. I also encouraged her to lay down.  She refused to lay down, but she agreed to the diphenhydramine. I gave her 25mg and told her I needed to give her another spoonful to give her the full dose. She refused. My technician gave her some water, but it was cold. The patient said she was starting to feel cold inside and wanted room temperature water. My technician went to get the water and the patient took a few sips. I took her blood pressure again and it had come down to 151/98 with a pulse of 67. The EMS team showed up and took over. They got a little information from me, but the rest was from the patient. I told them what I had done and what her last BP was. Their tech said their machine said her O2 level was fine and her BP and pulse did not indicate an allergic reaction. He looked at her back and arms and said the fact that she did not have any rash or hives made him think this was not an allergic reaction. She asked about the redness in the eye. He said that was not a typical allergy response, which was why he wanted her to be seen. He offered to take her, but also thought her husband could drive her if she didn't want to go in the ambulance. She said her husband cannot drive, so the decision was made to take them to the nearest hospital. The patient presented to the pharmacy with her concerns at 4:35. I administered diphenhydramine at 5:15.