Age: 26.0
Sex: F
Vaccine: HEP, MMR, VARCEL
Symptoms: Pallor, Skin warm
Clinical narrative: Pt presented today requesting Adult Hep B #1, Varicella #2 and MMR #1 for school requirements to become an EMT. Pt initially reported having an adverse reaction to the HPV vaccine in the past, which included throat swelling, difficulty breathing, low blood pressure and required EMS transport to the hospital and IV therapy for a few hours. Pt reported that she reviewed the ingredients to the MMR vaccine, and felt comfortable receiving this for the first time today. Pt reported history of other vaccinations out of state, but does not have an immunization record for review. Pt also reported an allergy to PCN, which involved "flu-like symptoms" x 1 month. Pt reported history of rheumatoid arthritis. Pt requested that RN measure BP before and after receiving vaccines today. BP at 1020: 118/82, R 18 (before vaccines). At 1030, Hep B administered into LAIM, then Varicella was administered LA SQ; pt tol well. Pt remained A & O, talking while receiving vaccines. MMR then administered into RA SQ. Within 1 minute, pt reported feeling "hot". Given sips of water by mouth. Face color became more pale and pt became diaphoretic. 1032: BP 122/74, R 22. Pt relocated from sitting in chair to supine on exam bed with minimal standby assist. Pt cont to be responsive to verbal communication. Reports feeling lightheaded. Nursing Supervisor, RN, into assist. 1038: BP 120/78, R 22, HR 73, SaO2 98%. Cooling measures taken, including ice pack to back of neck, cool wet cloth placed over forehead and fan provided. 1043: BP 120/84, R 20, HR 74, SaO2 98%. Pt reports that she is beginning to feel better. Remains supine, intermittently drinking water without difficulty. Pt reports that this feels differently than when she experienced an adverse reaction to the HPV vaccine. Pt then reports that she was given both the HPV and Varicella vaccines at the same time before, so was unsure which vaccine her past reaction was triggered by. Pt reports having received these vaccines at Medical Center. Alert records indicate varicella #1 dose received 09/23/2024 and #1 dose Hep B received 09/18/2024. HPV is not listed. 1046: Pt reports feeling well enough to try to sit upright. Assisted into high fowlers position, tol well. BP: 118/82, R 20, HR 87, SaO2 97%.  Pt remains alert and oriented x 3, having conversation with RN's in the room, drinking 200cc apple juice without difficulty, facial coloring returning to baseline. Skin is now warm and dry. Pt's wife, invited into exam room per pt request. 1053: BP 122/82, R 18, HR 85, SaO2 99%. Pt reports feeling "a little bit shaky" explaining that sometimes she has low blood sugar. Pt given chocolate chip granola bar, tol 100% of granola bar without difficulty. Pt continues talk appropriately with staff and wife. Total water by mouth: 600cc. 1059: BP 116/86, R 18, HR 71, SaO2 98%. Pt reports that the shakiness is gone. Pt expresses desire to stand up, reports feeling "much better". Standby assist to standing position, pt tol well. Pt initiates removal of BP cuff and pulse oximeter; stating she feels comfortable leaving the clinic now with wife. Discussed resting today from physical activity, especially if concerns arise, or seeking further emergency medical care PRN return of symptoms; having someone nearby available to assist as a precautionary measure. Pt expresses understanding and states she will be with wife today. Pt observed walking out of clinic unassisted, resp even and unlabored, no s/sx distress with wife at side.