Age: 12.0
Sex: F
Vaccine: HEP, HEPA, HPV9, IPV, MMR, MNQ, TDAP, VARCEL
Symptoms: Nausea, Pain in extremity, Pallor, Respiratory rate decreased, Speech disorder
Clinical narrative: On 11/15/22 patient came in to receive catch-up vaccines. She had one vaccine in the past about one year ago (Tdap). Father did ask about side effects and response if the patient received 8 vaccines. I discussed with the father that we have provided that many vaccines to patients in the past and they did well. But it It?s hard to know because everyone is different. Usual side effects are redness, some swelling at the injection site and the day after some fatigue. I stated that everyone response differently. He chose to do 4 out of the 8 vaccines but the patient wanted and insisted to do all 8 and get them over with so the father decided to do the 8 vaccines to get her caught up. I did educate the patient and father again of side effects-sore arm, and legs. Maybe redness and swelling at the injection site. If she did get a fever to give her Tylenol and or Ibuprofen as directed on the bottle. Patient was educated to drink water- stay hydrated and to move extremities for soreness. Patient and patients father voiced understanding.  At approximately 3:25 9 vaccines (Hep A, Hep B, MMR, Varicella, Tdap, IPV, HPV, Menquadfi) were administered to the patient. She received the vaccines in both right/left deltoids and 2 vaccines in both thighs- right and left. A few seconds after the last vaccine administration patient became unresponsive very pale, diaphoretic, and respirations decreased. She would respond to stimuli by opening her eyes. Her face and lips turned pale and she was had slow respirations. I precede to use the ammonia inhalant and that aroused her. Pt was not oriented. She would respond to her name and open her eyes. She was asked to say her name and she was unable to say her name or birthday. She stated she felt nausea and dizzy and wanted to vomit. She was given a few sips of water from her father. He assisted in trying to arouse and talk to her. She then vomited and stated she felt better. She continued to be pale and go in and out of consciousness so I used the ammonia inhalant and that aroused her.   At approximately 3:41pm called EMS and I drew up 0.45msl of epinephrine to have on hand. At approximately 3:50 EMS and fire department showed up. I gave them report of the situation and helped move the exam table out to lie the patient down they asked the patients father questions about allergies, last meal.  They took vital signs and monitored the patient. After about 35 minutes of the paramedics/ fire department monitoring the patient, she stated she felt better and she sat up. She was able to stand up and walk on her own around the room. At that time the patients father reported he felt comfortable taking the patient home. They set up the next visit in 2 months for one vaccine. I did educate both the patient and father that prior to that appointment make sure the patient has had something to eat, and to come in hydrated. They both voiced understanding. She exited the building ambulating next to her father. EMS and fire department also exited the building approximately the same time 4:25pm. 11/16/22 at approximately 10:52 a.m. I followed up via phone with the patient?s father on how the patient was feeling today. He reported that she stayed home from school because she did vomit in the morning. He reported that the patient stated she?s feeling better, she did report feeling tired and her arms and legs are sore. Re-educated patients? father on the important of movement in the extremities and keeping hydrated as much as possible. He voiced understanding. I did let him know I made a VAERS report and explained that to help. He voiced understanding. VAERS report done on 11/16/22.