Received Aug 15, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| UNK | VACCINE NOT SPECIFIED (NO BRAND NAME) | UNKNOWN MANUFACTURER | 2 | Y010656 | IM / LA |
Five minutes after the administration of HPV vaccine at 1420, patient became dizzy and fainted. She slumped over in a seated position and slid out of the chair, hitting her head on the floor. The patient quickly regained consciousness. Nurse noted a small, nickel-sized bruise on her forehead, left of midline. Vital signs at 1442 were BP: 102/60 and HR: 67. Mother was provided education on signs/symptoms of a concussion and to go to the ER if any of these occurred. Patient stated that she felt normal and then ambulated out of the clinic without issues at 1500. (name withheld)- Administrator, notified at 1505. (name withheld), RN/Patient Care Manager, notified at 1508 by (withheld name). VAERS form completed on 8/7/2025 and submitted to the IMM program for review.
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