Age: 17.0
Sex: M
Vaccine: HPV9, MENB, MNQ
Symptoms: Head injury, Joint dislocation, Loss of consciousness, Syncope, X-ray limb abnormal
Clinical narrative: After vaccination with MenACYW #2, Men B #2, HPV #3, Pt stated he felt lightheaded. CMA advised him to remain seated while she disposed of sharps. He began to stand up from the exam table then proceeded to slide down the side of the exam table and collapsed, hitting the right side of his head on the ground. After approx. 15 seconds he began to sit up. After CMA called for help, MD ran into the room and assisted patient off floor as he was trying to stand up and into a chair. Lead CMA instructed to bring a wheelchair and clear procedure room. CMA instructed to gather vitals cart. Patient rubbing left side of his head and saying he "blacked out" and did not remember falling. No pallor, increased WOB noted. Last reported memory was feeling dizzy after vaccines. Patient's head examined in exam room, no lacerations, bleeding, bruising, abrasions, or other signs of trauma noted. MD assisted Pt into wheelchair and lead CMA transported him to procedure room. Patient assisted into chair by MD and advised to lay supine. MD remained at patient's side throughout the remainder of the visit. Initial VS obtained as follows: BP 90/58, HR 58, no increased WOB. SBP 2nd and DBP 28th percentile for sex, age, and height. Lead CMA instructed to get a sugary drink and patient's father from the car and CMA advised to check blood glucose and get Vietnamese phone interpreter. Lead CMA returned with cold Sprite; patient advised to take a few sips which he did. Advised lead CMA to inform PM. BG checked and was 145. Pt then reported pain in his left clavicle and that he "think I broke it." Denies h/o previous clavicle trauma or displacement, previous syncopal episode. Reports he did not eat breakfast this morning. Clavicles exposed and examined. Distal Left clavicle internally displaced anteriorly by 0.5-1 cm, no broken skin, bruising or other skin changes, no crepitus noted. Gentle ROM of left shoulder elicited pain, no other abnormalities on upper extremity MSK, neurovascular exam noted. PULM exam CTA b/l in upper lobes, CV exam RRR w/o m/r/g. VS rechecked and was 123/73, HR 71. Pt reported feeling better and wanted to walk but he was advised to remain in the chair and continue drinking Sprite. Explained how Pt was doing to dad, the events leading up to his fall, confirmed his PMH, and apologized for what happened through medically certified Vietnamese phone interpreter. Addressed his questions about what vaccines were given (MenACYW #2, Men B #2, HPV #3), confirmed COVID vaccine was not given, explained normalized VS and blood glucose, explained likely vasovagal etiology of syncope and fall, and explained need for immediate evaluation by orthopedics for imaging and stabilization of left clavicle. Offered dad the option to go to clinic directly or ED, he preferred clinic. Confirmed a STAT order for ortho evaluation was being sent to clinic and he would be provided a copy of the address. Also advised dad I will be notifying VAERS about Pt's syncopal episode, and that he may do so as well. VIS for each vaccine with VAERS contact info, clinic address provided. F/u with ortho as directed, may return to school per ortho instructions. Informed dad I will have CMA call tomorrow to check on Pt, he agreed to call. After Pt felt better after 25 minutes and Dad's questions answered to his satisfaction, patient assisted into wheelchair by MD and assisted into car by MD which dad had pulled into the bay. Patient transported directly to clinic. CMA instructed to call clinic and inform them of patient's injury, VS, glucose, and need for medically certified Vietnamese interpreter.