Age: 16.0
Sex: F
Vaccine: HPV4, MEN
Symptoms: Alpha 1 foetoprotein normal, Cervical dysplasia, Drug exposure during pregnancy, Foetal disorder, Rubella antibody positive
Clinical narrative: Information has been received from a nurse for the pregnancy registry for HPV concerning a female with a history of vulvar condyloma with Trichloroacetic acid (TCA), treatment who was already pregnant when she was vaccinated IM with GARDASIL on 04-FEB-2008. The patient sought unspecified medical attention. At the time of this report, the patient was 9 months pregnant. Follow up information has been received from the physician reporting that other medication during this pregnancy included Prenate Advance and Meningitis (MCVH) immunization on 04-FEB-2008. The patient had a possible kidney stone in summer of 2007 and smoked marijuana during the early pregnancy. On 11-MAR-2008, the patient had a PAP exam which was abnormal/atypical squamous cells of undetermined significance. The patient was also screened for cystic fibrosis for which she was a negative carrier. On 17-MAR-2008, the patient had an ultrasound because she was unsure of her last menstrual period and it was normal, the EDC was 29-SEP-2008. On 21-APR-2008, the patient had a maternal serum alfa-fetoprotein test (AFP) which was normal. On 22-JUL-2008, the patient had sonogram for size less than dates which was normal. On 19-SEP-2008, the patient had another sonogram for size greater than dates which revealed fetal prominence of left renal pelvis. On 04-OCT-2008, the patient delivered a normal male baby vaginally. The baby had the cord wrapped around the left shoulder but there was not a complication. Pediatric medical records were received and reviewed and the following experiences were identified: On 04-OCT-2008 (baby's date of birth the baby's birthweight: 3684 grams (8 lbs, 2 ozs), length was 20.5 inches, head circumference was 35 1/2, apgars: 7/9, temperature: 99.5, Pulse: 144, respiratory rate: 52. The baby was given 1mg of PHYTONADIONE IM and ERYTHROMYCIN ointment to eyes. On examination he was noted to have molding head, bruising and caput left caephalohematoma, and mongolian spot. His skin was pink and he had some acrocyanosis. He passed his hearing test, and hepatitis B vaccination was refused. He also had minimal nasal flaring, minimal subcostal and substernal retractions. His oxygen saturation was 86% on room air, he had grunting. He was given blow by oxygen and the oxygen saturation was 94%. He was taken to the newborn nursery for observation of his respiratory status. Through the first 24 hours and on 05-OCT-2008 the nurses noticed some intermittent tachypnea. Respiratory rates were recorded as in the 50's and 60's and occasionally slightly higher but no grunting or retracting. Physician exam showed slight wheezing sound from the left side and rapid shallow respirations with a respiratory rate of 80. His skin had faint jaundice. The baby was admitted to the neonatal intensive care unit and blood cultures, complete blood count with differential and chest x-ray were obtained as well as a neo-SMAC. The initial blood count showed a white count of 15.4, hemoglobin 16, 2, hematocrit 44.9, 39 segs, 2 bands 49 lymphocytes, 4 monocytes. The baby was started on AMPICILLIN and GENTAMICIN. Chest x-ray showed streaky markings bilaterally, possible consistent with wet lung or infiltrate. Admission diagnosis was tachypnea and possible sepsis. On 06-OCT-2008 the respiratory rate remained in the 50's and 60's and the chest x-ray was unchanged. He continued on antibiotic and his bilirubin was 12.5. On 07-OCT-2008, vital signs were stable and he was feeding well. Chest x-ray showed resolving wet lung and white count was stable at 14.2, 29 segs, 50 lymphocytes and 17 monocytes and hemoglobin was 17.5. The blood culture was negative and the total bilirubin had come down to 13.5 and direct bilirubin of 0.6. the antibiotics were discontinued and the baby was discharged home to follow up on 10-OCT-2008. The discharge diagnoses were tachypnea, resolved, probable transient tachypnea of the newborn and blood cultures negative, and no evidence of sepsis. On 10-OCT-2008 the baby was seen in clinic. Exam showed that his circumcision looked pretty good with possibly some very minimal adhesions of the foreskin along the glans, but this was easily reduced. On 28-OCT-2008, the baby was seen in the clinic and the parent had concern of rash on face. ON examination he had mild facial milium which was benign, and he was healthy. Developmental screening, growth, hearing and vision screening were all normal. On 03-DEC-2008 at 2 month old the baby was seen for follow up and parent had concern that baby had congestion and wheezing. On exam, his lungs were clear, no rhino rhea, he had a little congestion and a cough. Assessment also was that the patient had 2 small hemangiomas on chest and cafe au lait spots on upper right back, and he had mild cradle cap for which application of olive oil was recommended. During a clinic visit on 25-FEB-2009, it was noted that on 13-FEB-2009 the baby had middle ear infection. On 25-FEB-2009, the parent had concern that the baby had diarrhea. The screening results showed that he had diarrhea and was to continue on baby cereal and keep hydrated. Upon internal review, the patient's mongolian spots and cafe au lait spots were considered to be congenital anomalies. No further information is available. Medical records will be provided upon request.