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Report #2900602

Received Jun 18, 2026

Office visit
A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex
Female
Age
12 yrs
State
CA
Recovered
Recovered
Vaccinated
Jun 17, 2026
Onset
Jun 17, 2026
Days to onset
0
Hospital days

Vaccines (3)

TypeNameManufacturerDoseLotRoute / Site
HPV9HPV (GARDASIL 9)MERCK & CO. INC.1Z012131IM / LA
MNQMENINGOCOCCAL CONJUGATE (MENQUADFI)SANOFI PASTEURUNKIM / RA
TDAPTDAP (ADACEL)SANOFI PASTEURUNKU8638AAIM / LA

Symptoms (2)

Pain in extremitySyncope

Symptom narrative

Came in for wcc and after I did all test and roomed pt I asked "step dad" if he wanted pt to receive 3 vaccine that she was due for and he mentioned "yes" so I stepped out of Exam room 2 and inform provider that pt was ready whenever she was ready and I also informed provider that per pt dad they wanted to get all 3 vaccines. After provider was done, she ordered the vaccine for me to administer to pt, all vaccines were verified by PNP and supervisor. I went in to administer vaccine and I had pt confirm date of birth and pt was nervous and provider had also mentioned that to me, so I started to give the pt the vaccine and we were talking, and I was distracting her by talking to her and everything went well. After I was done with the vaccines I asked if they would like a vaccine record since they had to wait 15 mins after the HPV vaccine was administered and they said yes. After I administer all 3 vaccine I did ask pt how are you feeling she said back good my arm hurts a bit. I stepped out of exam room 2 and I was able to log in on epic where the vaccine were given, after like 5 mins I was about to log in the IR to print out a yellow card of Vaccine pt dad stated yelling"hey,Hey,hey " as soon and provider and I heard that we went straight to exam rom 2 pt had fainted, after pt woke up provider stayed with pt while I grabbed the Bp machine and water and some granola bar. Provider did check bp and it was a bit low, provider dismissed her when bp was in average for pt age Supervisor and manager came to exam room 2 as well Manager: Supervisor contacted me right away to let me know. I then went towards exam room hallway checked in on everyone if they needed support. All staff reported hearing dad screaming and rushed to the back. Front desk printed out face sheet in case we needed it. I advise provider needs to fill out code blue form, Incident report, and VAERS form online. Vitals where taken by MA and provider and patient was monitored until she was ok to go.

Current illness

URI on 5/20/26

Medical history

none

Other medications

None

Allergies

none

Lab data

none