Sex: F
Vaccine: MNQ, VARCEL, VARCEL
Symptoms: Delivery, Drug exposure during pregnancy, Drug toxicity, Hyperglycaemia, Rhesus antibodies negative
Clinical narrative: Initial report and medical records were received 11 February 2011 from a health care professional. A newborn male infant had received a first dose transplacental administration of MENACTRA, lot number U3088AA and a first dose transplacental administration of VARIVAX (manufacturer Merck, lot number 1411Y) on 17 September 2010 and 139 days later, he experienced respiratory distress and hypovolemia following premature delivery that same day. Maternal drug exposures during pregnancy consisted of Prenatal vitamins and Cromolyn Sodium (start dates 21 September 2010), TYLENOL (for headache and aches/pains), TUMS (for heartburn), Ferrous sulfate 325 mg PO qd (for mild anemia), Insulin and LEVEMIR (for gestational diabetes) and unspecified antibiotics (for UTI, start date 02 December 2010). Maternal medical history consisted of eczema, premenstrual dysphoric disorder, headaches, occasional aches and pains, heartburn, UTI (diagnosed 02 December 2010), mild anemia, gestational diabetes, upper respiratory illness (four days prior to 31 January 2011), preterm labor, hypokalemia, and magnesium toxicity. Additional drug exposures received by the mother during labor and delivery consisted of LISPRO, Promethazine, magnesium sulfate, Sodium Chloride 0.9%, Dextrose 5% lactated Ringers, ampicillin, terbutaline, K+ supplement, Procardia, betamethasone and pitocin. The mother was a non-smoker, non-drinker, who had not used illicit drugs. On 03 February 2011, five hours after rupture of membranes, the patient, a live premature male infant, was delivered vaginally at 30+4 weeks gestation; apgar scores were 8 and 9 at one and five minutes respectively. He weighed 1560 grams, length was 43 cms and he had no congenital anomalies. Upon delivery, he was alert, active, pale pink, with a heart rate >100 with minimal retractions. He received blowby for five minutes and was admitted to NICU for observation and prematurity. Initially, he had good air exchange with saturations 100% on room air, but upon admission, he had respiratory distress evidenced by tight breath sounds with air exchange slightly decreased. Physical examination noted respiratory distress +, minimal retractions + bilateral equal air entry. The patient was also noted to be hypovolemic evidenced by poor perfusion with capillary refill of approximately 5 seconds and VBG with -3 base deficit. He received bCPAP 5cm and support as indicated and a chest x-ray was ordered (results not reported). Physical examination also noted facial and neck bruising with edema on the right side of his neck. GBS was unknown and Ampicillin and Gentamycin were started (for at least 48 hours) for septic workup. Blood culture was ordered (results not reported). UVC placement was performed. He was NPO with stock amino acid solution with urine output and weight to be monitored. Additional medications received consisted of Erythromycin ophthalmic, 1 application to both eyes beginning 03 February 2011. The patient's  outcome was not reported. The mother case has been captured in case number 2010-05327. Documents held by sender: Medical records.