Report #2871038

Received Nov 6, 2025

Office visit

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Overview

Sex: Male
Age: 11 yrs
State: AZ
Recovered: Recovered
Vaccinated: Nov 5, 2025
Onset: Nov 5, 2025
Days to onset: 0
Hospital days: —

Vaccines (4)

Type	Name	Manufacturer	Dose	Lot	Route / Site
FLUN3	INFLUENZA (SEASONAL) (FLUMIST)	MEDIMMUNE VACCINES, INC.	1	YF3413B	IN / NS
HPV9	HPV (GARDASIL 9)	MERCK & CO. INC.	2	Y019459	IM / RA
MNQ	MENINGOCOCCAL CONJUGATE (MENVEO)	NOVARTIS VACCINES AND DIAGNOSTICS	1	AH7Z3	IM / LA
TDAP	TDAP (BOOSTRIX)	GLAXOSMITHKLINE BIOLOGICALS	1	37R35	IM / LA

Symptoms (1)

Syncope

Symptom narrative

Patient fainted, the provider came into the exam room and evaluated and assesed the patient. Patient became alert and well. Patient remained in office for an additional 30min for observation.

Current illness

NONE

Medical history

NONE

Other medications

Albuterol Sulfate 108 (90 Base) MCG/ACT aerosol powder PRN

Allergies

PENICILLIN = RASH

Lab data

none