Age: 32.0
Sex: M
Vaccine: ANTH, TDAP, TYP
Symptoms: Hearing impaired, Loss of consciousness, Mini mental status examination, Pallor, Visual impairment
Clinical narrative: 0959: Saw patient being carried into laboratory and ran to assist.  Found patient supine on the floor, alert, oriented X4, with laboratory staff assisting him, raising his legs.  Patient noted to be pale.  However conversing without difficulty.  Directed HM1 to overhead page to Laboratory STAT, and assisted laboratory staff in transferring patient to lab chair from floor.  Transfer tolerated well, but paleness and weakness persisted.  Also describes dry mouth. 10:00 Dr. at patient's side, conducting Mental Status exam and physical exam.  Requested CODE BLUE be called, and corpsman directed to do so.  Immediate response of all available staff-vital signs machine requested immediately, and secured by corpsman. 10:04 V/S:  102/56, HR 58, RR14, 02 Sat 99%RA  Examination by Dr. continues, and patient remains alert/oriented X4  Patient reports he had received the following immunizations in our IMMS Clinic: Anthrax, Typhoid, Tdap, and a PPD-for which he'd plans to return to have read on Thursday.  Approximately 10 minutes after receipt of the immunizations (due to being a part of a group of coworkers here for same processes), he went to laboratory for draw.  Draw completed approximately 10 minutes later (per patient), as he waited for coworkers outside lab, he began to feel weak and clammy-and stood against the lobby wall.  He describes his vision "going black and narrowing in and then going back out a couple times, and my hearing was weird, and then when I noticed my vision was going black and not coming back out again, I walked over to the counter to tell them I didn't feel good, and the next thing I knew I was waking up here" (in the lab exam area where he'd been carried by lab staff). Patient (as well as lab stuff) concurs that estimate of duration of loss of consciousness was less than one minute. 10:05 Dr. requests that someone in the group he rode here with be notified of his condition and to be able to offer further assistance as necessary.  Determination by Dr. whether to activate 911 still in progress, as patient's symptoms seem to be resolving well. 10:09 V/S:  127/67, HR 67, RR16, O2 Sat 100% RA  Symptoms continue to resolve: less pale, less week, stronger voice.  Patient affirms feelings of improvement.  Dr. directs he be observed in situ, with Q5 V/S, and that she be notified for Systolic <100.  Repeated orders back were confirmed as correct.  (Another Code Blue was called around this time in a different location in the clinic, requiring Dr. presence.  RN remained chairside with patient, along with full complement of lab corpsman and MA's.) 10:14 V/S:  116/72, HR 58, RR16, O2 Sat 99%  Remains in chair in a modified semi-fowler's position.  Very conversant, remains A&OX4.   10:15 Dr. returned to patient's side.  Requested that he drink something with glucose in it, as he had been fasting all night prior to his encounters here.  Gatorade-like drink secured by HM2 and provided to patient, who took small sips without difficulty swallowing or any other problem. 10:18 Marked improvement in color and level of energy easily noted by Dr., all Code Blue staff at chairside, and again-affirmed by patient.  Dr. provided patient with verbal discharge orders, instructing him not to drive before he is further evaluated in an ER; that he must be seen today to insure no evolving process is occurring that might manifest itself later on, and that someone (other than patient) must drive/accompany him to ER.  Written order received (on 'scratch record') from Dr.: "Pt OK to D/C-with driver to ER", signed by her.  Patient verbalized understanding of all instructions and agreed with plan.  Also instructed, from an Immunizations perspective, that he will require documentation from a provider (his PCM/ER doc, etc) that states it's okay for him to proceed with further vaccinations required of the COCOM he is travelling to (CENTCOM) before any further immunizations can be provided. Understands that without this documentation, absolutely no further immunizations can be provided here.P atient indicated that he understood and would comply-pending final physician determination.  10:19  Patient assisted to standing position without difficulty.  HM2 instructed patient on standing-without holding on, as she stoodby to immediately assist him in case of fall or weakness.  Patient denied any negative sensations, such as those experienced at the beginning of this episode or during it.  Vital Signs taken while standing up, after a few minutes to equilibrate circulatory system: V/S:  (Patient Standing without assistance):  119/79, HR 79, RR18, OxSat 100% on RA. Patient confirmed his name and DOB for this nurse, and stated "I feel fine, I'm ready to go".  Walked out of lab without assistance, with steady gait-into lobby to his coworkers location.