Received Dec 8, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| UNK | VACCINE NOT SPECIFIED (NO BRAND NAME) | UNKNOWN MANUFACTURER | 1 | U8790AA | IM / LA |
The patient passed out for 30-60 seconds within 0-10 minutes of the vaccine administration. He was in a sitting position and fell off the chair on his knees when he passed out. Once he got conscious, he was A&Ox4, but diaphoretic, clammy, bradycardic (HR 36 initially), BP 120/70. He said he got nauseous prior to passing out. The fall was witnessed by the clinic's provider who also was the reporter, and his parents who came to his aid. They were later assisted by the clinic's PCP. He was observed for 30 minutes, until he was stable and his vital signs were normalized. He left with his parents on foot to their vehicle
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vital signs, patient observation, patient declines further evaluation to Urgent Care/ER, said he was fine, and his parents agreed