Received Oct 31, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| TD | TD ADSORBED (TENIVAC) | SANOFI PASTEUR | UNK | U8385BA | IM / RA |
| VARCEL | VARICELLA (VARIVAX) | MERCK & CO. INC. | 2 | Z004245 | SC / LA |
29 year old patient presented to the clinic for a tetanus booster. Reviewed patient's name, dob, and allergies. Reviewed patient's vaccination history; patient's last tetanus vaccine was on 07/18/2015 where the patient received a Tdap vaccine. Patient also had titers drawn on 07/16/2015 for Varicella Zoster with "negative-NOT Immune" results. Patient received a dose of Varicella on 07/18/2015 and 08/09/2015. Advised patient the 2nd Varicella immunization was given too early and advised patient that a dose should be administered now to ensure proper immunization according to CDC guidelines. Patient is agreeable to receiving Td and Varivax vaccines. Pre-vaccination Assessment was as follows: Routine Vaccine Screening: "Are you sick today?: No Have you ever had a serious reaction after receiving a vaccination: No Do you have allergies to medication, food, a vaccine component, or latex?: No Have you had a seizure or a brain or other nervous system problem?: No Have you had a health problem involving heart, lung (e.g., asthma), kidney, or metabolic disease (e.g., diabetes), anemia, or other blood disorder?: Yes Do you have cancer, leukemia, HIV/AIDS, or any other immune system problem?: No In the past 3 months, have you taken medications that weaken your immune system, such as prednisone or other steroids; anticancer drugs; biologic drugs for: No In the past year, have you received a transfusion of blood or blood products, or been given immune (gamma) globulin or an antiviral drug?: No Have you had (or are you a candidate for) your spleen removed, or do you have sickle cell anemia?: No Have you ever passed out (had vasovagal syncope) during or after a previous immunization or blood draw?: Yes Have you received any vaccinations in the past 4 weeks?: No Are you pregnant or is there a chance you could become pregnant during the next month?: N/A Routine vaccine comments: Pt reports a dentist in childhood "discovered a heart murmur, but no one else was able to detect it and there was no further work up done." Pt reports hx of "passing out once during a blood draw and once during anthrax vaccination." No contraindications." Reviewed further history with patient: Patient reported a history of "passing out twice: once during a blood draw where they were digging around in my arm and had to stick me three different times and the other when I got the anthrax vaccine. It seems to happen when they're really painful." Advised the patient that he will remain in the chair for at least 5 minutes after vaccination to ensure no vasovagal response. Patient advised after the 5 minutes to remain in the clinic for an additional 10 minutes to ensure no adverse reactions to vaccination. Per the patient's current medical history there were no contraindications to the requested immunizations. The patient did not appear ill or in distress; there was no edema, erythema, rash, or tenderness noted at the injection sites. Patient's right deltoid was cleaned with an alcohol swab in a circular motion and allowed to dry naturally. Intramuscular injection of Tenivac was administered at 1605 at a 90 degree angle 3 fingerbreadths below the acromion process. The patient was able to maintain conversation throughout the injection. The posterior aspect of the patient's left arm was then cleaned in the same process as mentioned previously. The skin was pinched and the subcutaneous injection of Varivax was administered at 1607 at a 45 degree angle. Patient was able to maintain conversation throughout the injection but mentioned at the end "the medicine really burned with that last one." Patient denied any other symptoms at that time. Post-Vaccination Assessment: 1. Attempted to have patient move into Archimed chair, a chair with arm rests that can be adjusted into Trendelenburg position as needed, but patient refused and wanted to stay in the chair he was in. Reminded patient that he was to remain in the chair for at least 5 minutes to make sure he feels okay before standing up, patient verbalized his understanding again. After about 3-4 minutes, the patient called out and stated "I'm starting to feel funny." Pallor noted to patient's face. I repositioned myself in front of the sitting patient with one foot in between the patient's feet in case of loss of consciousness. The patient then went limp. I then grabbed the patient by his utility belt (patient was in uniform), to keep the patient upright. I assessed the patient's consciousness via the shout, tap, shout method. The patient was not responding, the patient's body then went rigid. I then began to reposition the patient to the floor using his utility belt, right as repositioning began the patient regained consciousness and began apologizing. The patient was able to answer questions but stated "I still have a ringing in my ears right now." The patient was cooperative with assisted ambulation to the Archimed chair where he was placed in Trendelenburg position. Public Health Nurse came into Immunizations Office and stayed with the patient while a Physician was obtained to further assess patient. Report was obtained at 1620, patient reported he was feeling much better and color had returned to his face. Dr. stated he was okay with the patient discharging at that point. The patient sat with legs dangling on the side of the chair for 1-2 minutes prior to standing, staff was on standby at patient's sides in case of orthostatic hypotensive episode. Patient was steady and ambulated appropriately independently and was able to put jacket back on unassisted. Patient discharged from the Clinic around 1625. Followed up with the patient the next morning and patient denied any further symptoms since the episode experienced at the clinic.
Patient denied
Patient denied
Sterile diluent For Merck Sharp & Dohme LLC Live Virus Vaccines (used to reconstitute Varivax)
Patient denied