Received Sep 30, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| FLU3 | INFLUENZA (SEASONAL) (FLUZONE) | SANOFI PASTEUR | 1 | UT8770NA | IM / RA |
| HEPA | HEP A (HAVRIX) | GLAXOSMITHKLINE BIOLOGICALS | 1 | J4K4X | IM / RA |
| HPV9 | HPV (GARDASIL 9) | MERCK & CO. INC. | 1 | Y018398 | IM / LA |
| MNQ | MENINGOCOCCAL CONJUGATE (MENQUADFI) | SANOFI PASTEUR | 1 | U8573AA | IM / RA |
| TDAP | TDAP (ADACEL) | SANOFI PASTEUR | 2 | U8122AA | IM / LA |
| VARCEL | VARICELLA (VARIVAX) | MERCK & CO. INC. | 2 | Y019318 | IM / LA |
After last vaccine was administered, pt began leaning/falling backwards with eyes partially assisted him in sitting upright. Pt then began displaying bilateral arms and legs stiffening, and pt was unresponsive. Pt then displayed full body jerking for approximately 5 seconds, remaining unresponsive. Foaming saliva was noted in the edge of his mouth. He was lowered onto his side on the exam table, in the recovery position. Additional staff arrived and 911 was called. Pt skin was pale, warm and moist. Pt quickly began responding and was alert and oriented to person and place. Pt was tearful and nervous. Pt remained in lying position on exam table. Mom and Dad both remained in the room, with Mom at the bedside. EMS first responders arrived and assumed care of pt. Pt was transported to hospital for further evaluation. Follow up on pt on 09/29/2025 when in facility d/t needed school physical. Pt and parents report child has been feeling well since 9/26/25. Pt appears well and is in no distress. Pt mother and father reported pt had CT scan, bloodwork and "they checked his heart" while being seen in the ER on 9/26/25. Parents were given instructions for pt to f/u with a provider if he experienced similar episode again.