Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Anion gap, Asthenia, Basophil count normal, Basophil percentage, Blood chloride normal
Clinical narrative: Pt vomitted and episodes of N/V,episodes of syncope, weakness  Sister states pt's LOC is not at baseline.  Pt has photophobia, HA, neckpain, and is calmmy Vitals @17:35: 108/67,70,22,97.5F, 98% on RA, A&Ox2 911 was called at 17:32. Pt arrived in ED 18:08 Chief Complaint Patient presents with ? Loss of Consciousness from specialty clinic, had first dose of moderna vaccine, pt had episode of vomiting and eyes rolled back during the 15 minute waiting period. Now back to baseline.     HPI: 25 yo male complains of syncopal event post receiving Moderna vaccine. His eyes rolled back with LOC N/V when awoke No Seizure activity Now complains of HA and feeling weak No Loss of BB control To oral injury     Past Medical History: Diagnosis Date ? Tonsillitis       History reviewed. No past medical history pertinent negatives.   History reviewed. No pertinent surgical history.   Home Medications Prior to Admission medications  Medication Sig Start Date End Date Taking? Authorizing Provider ondansetron (ZOFRAN) 4 MG tablet Take 1 tablet by mouth 3 (three) times daily as needed for Nausea. 1/31/23      SUMAtriptan (IMITREX) 25 MG tablet Take 1 tablet by mouth as needed for Migraine. Once at onset. If no relief, may repeat once after 2 hours 1/31/23          No family history on file.   Social History   Tobacco Use ? Smoking status: Never ? Smokeless tobacco: Never     Review of Systems  Constitutional: Positive for fatigue. Negative for chills and fever.  HENT: Negative for mouth sores and trouble swallowing.   Eyes: Negative for photophobia and visual disturbance.  Respiratory: Negative for shortness of breath.   Cardiovascular: Negative for chest pain.  Gastrointestinal: Positive for nausea and vomiting. Negative for abdominal pain.  Genitourinary: Negative for difficulty urinating.  Musculoskeletal: Negative for neck pain and neck stiffness.  Skin: Negative for rash.  Neurological: Positive for syncope, weakness and headaches. Negative for dizziness, tremors, seizures, facial asymmetry, speech difficulty, light-headedness and numbness.  Hematological: Does not bruise/bleed easily.  Psychiatric/Behavioral: Negative for confusion.      Physical Exam BP 121/73  | Pulse 96  | Temp 36.7 °C (98.1 °F) (Temporal)  | Resp 18  | SpO2 98%    Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: He is not in acute distress.    Appearance: Normal appearance. He is well-developed and normal weight. He is not ill-appearing, toxic-appearing or diaphoretic.  HENT:     Head: Normocephalic and atraumatic.     Right Ear: External ear normal.     Left Ear: External ear normal.     Nose: Nose normal.     Mouth/Throat:     Mouth: Mucous membranes are moist.     Pharynx: Oropharynx is clear.  Eyes:     Extraocular Movements: Extraocular movements intact.     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Abdominal:     General: Bowel sounds are normal.     Palpations: Abdomen is soft.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Normal range of motion and neck supple.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes 2 to 3 seconds.  Neurological:     General: No focal deficit present.     Mental Status: He is alert and oriented to person, place, and time.     Cranial Nerves: No cranial nerve deficit.     Sensory: No sensory deficit.     Motor: No weakness.     Coordination: Coordination normal.     Gait: Gait normal.     Deep Tendon Reflexes: Reflexes normal.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.          ED Course   Procedures Procedures   Medical Decision Making Amount and/or Complexity of Data Reviewed Labs: ordered. Decision-making details documented in ED Course. ECG/medicine tests: ordered and independent interpretation performed. Decision-making details documented in ED Course.     Risk Prescription drug management.   Risk Details: No orthostic hypotention Vagal response to shot vs Moderna reaction       Orders Orders Placed This Encounter Procedures ? Hemogram with differential ? Panel 7 ? ECG 12 lead     Imaging No results found.   No orders to display       ECG Interpretation Heart Rate: Normal Heart Rate: 74 bpm Rhythm: Regular Complex: Narrow QRS Axis: Normal Intervals: Normal QTc: 408 ms Evidence of Acute Myocardial Injury: No STEMI Activated?: No     Labs    Results for orders placed or performed during the hospital encounter of 02/08/23 Hemogram with differential Result Value Ref Range   WBC Count 17.21 (H) 3.90 - 10.60 x1000/mcL   RBC Count 5.02 4.50 - 5.90 x mil/mcL   Hgb 15.2 13.5 - 17.5 g/dL   Hematocrit 42.8 41.0 - 53.0 %   MCV 85.3 80.0 - 100.0 fL   MCH 30.3 26.0 - 34.0 pg   MCHC 35.5 32.0 - 35.5 g/dL   RDW 12.0 11.5 - 14.5 %   Platelet Count 371 140 - 450 x1000/mcL   MPV: Mean Platelet Volume 9.6 9.0 - 12.0 fL   Neutrophils, Auto 79.9 (H) 51.0 - 75.0 %   Lymphocytes, Auto 13.5 (L) 24.0 - 44.0 %   Monocytes, Auto 5.5 1.0 - 9.0 %   Eosinophils, Auto 0.5 0.0 - 4.0 %   Basophils, Auto 0.1 0.0 - 1.0 %   IG %: Immature Granulocytes Ratio 0.5 0.0 - 1.0 %   Abs. Neutrophils, Auto 13.75 (H) 1.80 - 7.70 x1000/mcL   Abs. Lymphocytes, Auto 2.33 1.00 - 4.80 x1000/mcL   Abs. Monocytes, Auto 0.95 (H) 0.00 - 0.80 x1000/mcL   Abs. Eosinophils, Auto 0.08 0.00 - 0.50 x1000/mcL   Abs. Basophils, Auto <0.03 0.00 - 0.20 x1000/mcL   IG #: Immature Granulocytes Count 0.08 0.00 - 0.10 x1000/mcL   Results Comment Results auto verified   Panel 7 Result Value Ref Range   Sodium 140 135 - 147 mmol/L   Potassium 3.5 3.5 - 5.0 mmol/L   Chloride 103 96 - 106 mmol/L   CO2 25 22 - 31 mmol/L   Anion Gap 12 10 - 18 mmol/L   Glucose, Random 101 70 - 200 mg/dL   BUN 10 5 - 25 mg/dL   Creatinine 0.94 0.67 - 1.35 mg/dL   GFR Estimate 115 77 - 179 mL/min/1.73m2         Diagnosis Vaso Vagal Syncope  Medications Medications sodium chloride 0.9 % (NS) IV bolus 1,000 mL (has no administration in time range) prochlorperazine edisylate (COMPAZINE) injection 10 mg (has no administration in time range) ketOROLAC (TORADOL) injection 15 mg (has no administration in time range)     New Prescriptions   No medications on file   Stable for DC Improved with IVFs   ED Course as of 02/08/23 2155 Wed Feb 08, 2023 2154 WBC Count(!): 17.21 Stress response, no S/S of infectious etiology.    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