4/11/2022 @2:10PM 20yo female came in for flu and t-dap vaccination was accompanied by mom. Vaccine information sheets (VIS) were distributed to the patient along with health screening questionnaire by the vaccinator. While the vaccines were being prepared, the health screening questionnaire was distributed to the patient and filled out by the patient. The questionnaire was reviewed by vaccinator prior vaccinating. Patient marked yes on question #4 regarding long term health problems, stating that she has Asthma and is using an inhaler. There were no observed contraindications with the flu or T-dap based upon the patients? self-report. The patient asked if it is normal to feel nauseous after getting flu vaccine. Patient concern was answered accordingly and there weren?t any further questions.    At approximately 2:18PM T-dap was first given on the left arm, then the vaccinator proceeded with flu quadrivalent vaccine given on the right arm. The patient was observed to be fine while the vaccinator was inputting shot records into system. The vaccinator stepped out their room to print the patient?s shot record, 10 feet away with office door open. The vaccinator heard mom calling to patient, asking if she was okay. The vaccinator ran into the room and the patient?s mother stating, ?she?s fainting.? The patient stated, ?I?m going to faint.? The vaccinator kept the patient in her seat and leaned the patient backwards to prevent her from falling forward. The patient appeared pale, diaphoretic, and briefly became unconscious.    The vaccinator then grabbed the O2 tank behind the door and yelled for help. The vaccinator noted that the patient woke back up within 10 seconds. PHN came in to assist immediately. At 2:24 pm O2 was administered via non-rebreather mask @8L/min. O2 was at 100%, BP 114/84, HR 93, AOX3. During the vital sign assessment, the patient?s color gradually returned. Water and hard candy were offered to the patient. The vaccinator offered to call EMS, the patient declined the offer with mom room, stating, ?I have no insurance.? The patient declined with the patient?s mother present.   At 2:29 pm vital signs were reassessed. BP 122/84, HR 84, O2 98%, and AOX3. The patient intermittently used their O2 mask. PHN asked if the patient needed us to call an ambulance for her. The patient declined. The vaccinator advised the patient about emergency insurance. During the observation mom and patient state that it is common for her to faint after getting vaccinated and this was not her first time. This was not communicated at any time prior to immunization. The patient was observed to be stable.   Around 2:55 pm, the patient and mom were ready to leave, and the vaccinator had the patient stand. The patient self-reported and stated that she felt dizzy and said that she was going to faint. The vaccinator then sat the patient back down. O2 @10L/min was administered via NRM. BP 140/90, HR 83, AOX3 and O2 100%. The patient began to complain of chest pain/tightness with a pain of 4 out of 10. The patient then became lethargic. In the meantime, LVN, tried to call clinical doctors for advice. PHN asked again if the patient would like us to call EMS for assistance, stating that he?d be more comfortable with healthcare monitoring her on the way to the hospital. The patient?s mother stated that she would like the same, but the patient refused the idea of calling an ambulance, citing that she did not have insurance.     3:00 pm BP 140/100, HR 84, O2 100%, AOX3, with O2 given at 10L/min via NRM. The patient continued to present lethargic. LVN offered to call an ambulance and patient declined with the patient?s mother and  PHN and the vaccinator present. At 3:10 pm the BP was unable to be obtained. HR 83, O2 99%, with no O2 administered. Lower back pain and chest pain were noted at a level of 4 out of 10. PHN stated that he was not comfortable with the patient?s chest pain and lethargy, and that he felt that she should be taken by ambulance to the emergency room and once again asked the patient if she would like for us to call EMS. The patient declined.   LVN and PHN Continued to monitor patient while I called Dr.  at 3:13 pm and left a message stating the patient?s condition, assessment, and vital signs. At 3:19 pm, BP 138/72, HR 93, O2 98%, AOX3, with no O2 administration. Patient continued to present lethargic. Pain level was a 4 out of 10. In both the chest and back. LVN stated that she felt that the patient should be sent out via ambulance and offered to call EMS once again. Patient declined. Mom had called relative to help with driving the patient to hospital, with the patient?s refusal to have EMS called.     At 3:39 pm, Dr.  called the vaccinator back and reaffirmed that ?patient should go to the ER.? At that time, the staff offered to call EMS so that the patient could be taken to the hospital via ambulance.  The mother agreed that she felt it would be best, not knowing what she would do if the patient passed out again.  The patient refused the idea of being taken to the hospital via ambulance.   At 03:40 pm, BP 140/90, HR 90,  AOX3, and O2 98%. The patient was assisted to the car via wheelchair by staff at 3:57 pm.