11:28 am:  Patient returned to center multiple times in reference to prevnar 20 vaccine received earlier today. On first occassion about 45 mins-1 hour after vaccine was administered patient had questions why vaccine was administered if he received the pneumovax 23 last year. Also stated he researched online and called his "nurse friend" that told him he did the wrong thing as recommendation is every 5 years not after 1 year. Patient was advised per CDC guidelines patients should receive a dose 1 year after to complete series after receiving the puemo 23. Patient stated he was misinformed and misguided by practioner as it was not mentioned that he previously had dose and if he would have know he would not have taken vaccine especially since he is anti vaxer and does not believe in them. Patient was also educated that although it may seem to seen puemo 23 and prevnar 20 cover against different strains of the pneumococcal disease.  RN used CDC Pneumo vaccine application and had patient answer all questions for himself that led to recommandation stating he should receive a dose 1 year after receiving pnuemo 23. Patient was also reminded on several occassions that RN gave him multiple opportunities to refuse vaccine as it is his right to refuse. Patient stated he knows but knowing dose was given last year 1 year is way too soon and he was distracted by MD. Patient reassured, advised if it was indeed too soon the guidelines would not exist but they do and it is through multiple studies that the guidelines are formed. Patient asked what should he look out for to know if he has to go to the emergency room. Advised if he experiences trouble breathing, chest pain, numbness/tingling or is in overall distress at any time to visit nearest ER. Verbalized understanding and left.  Patient returned within 20 minutes of interaction with symptoms that he states are due to prevnar 20 vaccine. Reporting b/l ear ringing, stating this is the cause of vaccine cause he did not have this when he first came into center. MD made aware and advised patient to go to nearest eye and ear doctor to be evaluated as they take walk ins and can assess him right away. Patient relucantant, questioning what they are going to do for them. Advised they are specialist and can do diagnostic testing more than we can offer in office. Patient kept repeating this all started because he was given vaccine too soon, repeatedly stating he does not believe in vaccines. Patient then complained of left sided facial pain and burning sensation in tounge. Patient not in apparent distress, able to breath without problems. Noted to be nervous and doubtful, again started saying he received vaccine too soon. Online search he started reading again saying its 5 years not 1 year. Patient reassured once again, reminded he himself entered the information in the puenmo app and he saw recommeded dose was to be given after a year. Patient advised since he is experiencing all these symptoms at this time RN is recommending he visit nearest ER. Patient refused stating he has to go to work and if he doesn't he will not get paid for the holiday, advised health comes first and he will have proof he went to ER to be evaluated. Patient hesitating once again asking what they are going to do for him. Advised the hospital capability is far more superior than UC and they can run test and have results immediately to know what is going on. Patient again blamed symptoms on vaccine. Discussed symptoms may be independent of vaccine and is why recommendation to go to ER has been advised.   Patient walked out of room very skeptical. Began saying he has never had a doctor not care about his health as MD should have rushed to room to see him. Patient was reassured that MD cares and it is why when she was informed she recommended he sought immediate care to be evaluated. Patient did not agree, again saying he should not have taken vaccine.   9/6/2023 5:02 PM Patient complains of: Pt  got the Prevnar 20 vax on 9/1 . Since then pt feels both ear ringing, muscle pain, sour taste in the mouth and now blurry vision. Pt was told to go to his near ER hospital and was informed patient needed to speak with his PCP about it : Per patient he was told nothing can be done for him in the ER for symptoms mentioned above. Also mentioned he reported to ER that he was having chest pain and had work up. For side effects from vaccine, he was advised he must return to PCP to discuss and be evaluated for any potential treatment. Patient ongoing that he should not have gotten vaccine and he was not informed by MD. States he immediately felt symptoms as soon as he received vaccine. Patient advised he was speaking to RN that administered dose and he did not report any side effect when vaccine was given. Demeanor was calm and collective when he left consult room.  It was not until he returned to center and remembered he had puemo23 last year, which he reported no reaction to, that he began stating he felt ringing in ears. As more time went by during explanation of scheduling of pneumo vax that patient reported more and more symptoms. Patient went on to say he was misinformed and now he will get stuck with hospital bills because he received a vaccine that was not suppose to be given. Patient even stated he would probably "be dead" if he took both vaccines that PCP had recommended that day. Patient reassured MD would not advise anything that may cause harm. Offered next day appt with practioner for symptoms as PCP's available time did not work for him but declined. Appt scheduled with Dr. 940AM on 09/08. Agreed to bring discharge papers.