Age: 26.0
Sex: F
Vaccine: HPV4
Symptoms: Drug exposure during pregnancy, Foetal disorder, Gestational diabetes, Human papilloma virus test negative, Viral DNA test negative
Clinical narrative: Information has been received from a Nurse Practitioner concerning a 26 year old female with a history of 0 pregnancies and 0 live births and a history of ventricular tachycardia and Papanicolaou smear abnormal who on 12-JUN-2007 was vaccinated with her first dose GARDASIL (lot#0211U).  Concomitant therapy included ORTHO TRI-CYCLEN LO).  The patient later found out that she was pregnant with an LMP of 15-MAY-2007.  The patient also had an HPV test which tested negative.  Medical attention was sought.  Follow-up information was received on 27-May-2008 from a nurse who indicated that the patient delivered a healthy baby girl on 15-FEB-2008.  The baby was normal and healthy with no congenital anomalies.  Follow-up information was received from an outcome pregnancy questionnaire.  The patient weighed 8 pounds 4 ounces.  The Apgar score was 9 and 9.  The patient was 39 and 1/2 weeks from LMP.  The infant was not normal and she had mild metatarsus adductus and mild curly toe deformities.  On an unspecified date the patient had OB testing and labs revealed gestational diabetes which was under diet control.  During pregnancy the patient received OBTREX for pregnancy.  Medical records were received from the physician's office for the baby.  On 10-APR-2008 the baby had a 6 week follow-up visit with the physician.  The baby has a bilateral foot.  The baby is almost 2 months of age.  Overall the baby was doing well.  Her mother does not have any new concerns or complaints.  The baby has not had any recent fevers or other systemic signs of illness.  The baby was well developed, well nourished, alert and no acute distress.  An exam of the bilateral lower extremities reveals full range of motion of all joints, neurovascularly intact through out.  Leg lengths were equal.  Skin folds were symmetric.  Barlow, Ortolani and Galeazzi tests were negative.  Exam of the feet does reveal mild metatarsus adductus deformities.  The calcancovalgus deformities are already correcting.  Mildly curly toe deformities exist of the 4th toes bilaterally.  A radiograph was performed and revealed AP pelvis, legs together and legs apart, reveal the hips are well reduced in the sockets.  The Shenton's lines are intact.  Acetabular indices measures 28 degrees and 29 degrees on the left and 27 degrees and 22 degrees on the right.  A second radiograph revealed AP bilateral feet reveal normal-appearing osseous structures.  There was no evidence of shortening of the 4th metatarsals.  The flexion deformities of the 4th toes are noted.  The assessments included hip click, metatarsus adductus and contracture of joint and ankle and foot.  The physician has advised the mother of the findings.  The baby does not have a club-foot nor does she have clinical or radiographic evidence to suggest hip dysplasia.  The contractures and deformities which she has of the feet and ankles appear to be benign and positional.  These issues should be resolved as the baby begins to weightbear and the soft tissue contractures stretch out over time.  No other treatment was indicated for the baby other than observation.  The baby is going to be seen again at one year of age for reevaluation of the lower extremities.  No x-rays needed.  The reporter considered the mild metatarsus adductus and mild curly toe deformities were considered to be congenital anomalies.  Additional information is not expected.