Age: 17.0
Sex: F
Vaccine: HPV4, MMR, MNQ
Symptoms: Malaise, Nausea, Pain, Tremor, Vision blurred
Clinical narrative: Patient presented to office at 0830 for vaccines. MMR, Menactra, and HPV administered by nurse at approximately 0845. Patient went to waiting room after vaccinations for approximately 10-15 minutes.  At about 0900, Patient presents back to nurse's office and reports that she felt "funny" after first vaccine, but did not think much of it. Dizziness and shaking worsened while waiting in waiting room and difficult to focus while trying to read her book. Blood pressure at that time noted to be 110/78 and pulse 84. Client states she ate breakfast, does not feel faint, just dizzy. Sprite provided for client and offered to let her lie down. Client states she feels fine in chair. 0915:  Client states dizziness and shaking remian the same.  Client is conversing with nurse.  Conversation appropriate and alert and oriented X 3.  0930: patient's mother was present to sign for vaccines and ask questions, but left before vaccine was given. Mother of child called at 0930 to inform her of situation. Blood pressure 108/74.  Mother of child came to the office to get child. 0945: Client states dizziness/shaking the same. Conversing with nurse appropriately.  1005:  Dr's office notified regarding patient's condition.  Physician not in office at this time, but clerical staff planned to relay message and return call to client for further recommendations or advice.  Client discharged to home with mom and sister.  States still has shaking feeling, but no worse than it was at 0900.  Patient has a history of hypothyroidism and is considered prediabetic.  She is on Synthroid and Metformin.  Was also diagnosed with pancreatitis in 11-07 with unknown cause.  Patient's approximate weight is 225 pounds.  1615:  Telephone call to patient to follow up on condition.  Child not home, mother reports that she slept for about 4 hours after leaving office and now feeling a little better.  Still a little dizzy and nauseated, but did go to work at Firesteel.  Dr. returned call to family and was not concerned at this time.  Stated that client could take Benadryl if desired.  If patient feeling worse or if symptoms persisted, she was instructed to go to emergency department at hosptial.   5-12-08  1240-  Telephone call to mother of child to follow up on condition.  Mother of child states that dizziness was gone by Saturday.  Patient was complaining of some arm discomfort where injections were given, but pain getting better.  5-13-08  1115  Patient called office this morning and spoke with nurse, complaining of still not feeling well.  States she was "slurring her words" last night at work and felt "almost confused" while at school yesterday.  States she felt very dizzy this morning upon awakening and nauseated, almost like she was going to "pass out."  Patient reports that she is feeling very fatigued and stayed home from school today.  Left arm is very uncomfortable and is taking Ibuporfen for discomfort.  Patient's conversation very appropriate while on phone with nurse.  Strongly recommended that patient call family physician to report symptoms.   1510- Nurse telephones client to follow up on call to physicain.  Mother of child answers phone, as patient is sleeping.  States that she is still shaky and feeling fatigued and having generalized numbness.  States that patient did speak with someone at Dr's office and was told that she would be seen tomorrow if symptoms were not gone.  Mother of child is planning to take her to the emergency department if not feeling better this evening. 5-14-08 1355  Telephone call to family to determine if family had spoken with physician or if client feeling better.  Mother of child states that child was feeling a little better and did go to school today.  Family did not talk to Dr's office today.  1330  Telephone call to client per her mother's request.  No answer, left message.  1615  Telephone call to patient to follow up on condition.  No answer, left message. 5-15-08  1415  Telephone call to patient to follow up on condition.  No answer, left message.  VAERS form completed today