Sex: F
Vaccine: HPV4, TDAP
Symptoms: Caesarean section, Constipation, Coombs test negative, Dermatitis atopic, Foetal exposure during pregnancy
Clinical narrative: This spontaneous report as received from a physician and a other health professional refers to a female infant. On 30-AUG-2012, the patient's 18 years old mother was vaccinated with GARDASIL, lot number reported as (0420AE), expiration date 01-DEC-2014. Concomitant medications included: ADACEL which was administered on 30-AUG-2012 to a separate site. The mother also received OTC (over the counter) vitamin B6 and unspecified prenatal vitamin during pregnancy, and received azithromycin on 18-SEP-2012 for the treatment of chlamydia. On a unknown date in September 2012, the mother was found to be pregnant with nausea. The last menstrual period (LMP) was on 06-AUG-2012. Estimated conception date was on 20-AUG-2012. The pregnancy concerned the patient's first pregnancy. The mother delivered a full term infant at 38 weeks via C-section. The C-section was done for intrauterine growth restriction (IUGR) with the baby measuring 33.5 weeks. The female baby, was 5lb 15oz with APGARS 9 and 9. Her head circumference was 12.5 and length 18.5 Doctor confirmed that baby was doing great and was completely normal and healthy. Upon internal review, intrauterine growth restriction was determined to be medically significant event. The mother's event was captured in 1209USA008700. Additional information was received. On 29-APR-2013 the patient was admitted. On 29-APR-2013, the patient's lab data included bilirubin 5.6 (units unspecified) Blood type was 0 positive. Coombs test negative (units unspecified), Blood sugar 70 (units unspecified), hematocrit 38 (units unspecified), PKU 6917345 (units unspecified). Hearing test passed bilaterally. It was reported that Hepatitis B vaccine was given. The Maternal blood type was O positive. The Serology included human immunodeficiency virus and hepatitis B negative. It was reported that the patient was Rubella immune. The Birth weight was 5 pounds and 15 ounces. The Discharge weight was 5 pounds and 11 ounces. Ultrasound showed the baby to be sizing at 33-112 weeks. BPP was 8 out of 8. Non-stress test was reactive. Mother was scheduled for a cesarean section at 38 weeks. Placenta was sent to pathology. She was bottle feeding. On 14-MAY-2013, the patient underwent an Early Periodic Screening, Diagnosis, and Treatment (EPSDT) which revealed the Body mass index was 11.12 (units unspecified), the body surface area was 0.19 (units unspecified), height 1 feet 7.5 inches, weight 6 pounds 2 oz, temperature 99.1 Fahrenheit axillary, head circumference 35.5 centimeters. Birth weight 5 pounds 15 oz. On 28-MAY-2013, the patient underwent an Early Periodic Screening, Diagnosis, and Treatment (EPSDT) which revealed no growth, development, feeding and sleep concerns. She was diagnosed with oral thrush. Reported bowel movement changes included constipation. Skin problems included seborrhea and atopic dermatitis. Anticipatory guidance addressed as per the history of present illness section. DTaP, Hib, IPV, Hepatitis B, Rotavirus, and Pneumococcal were administered. Information discussed with mother and aunt. The Body mass index was 11.95 (units unspecified), the body surface area was 0.21 (units unspecified), height was 1 feet 8.5 inches, weight 7 pounds 2 oz, temperature 99.6 Fahrenheit, heart rate 168 (units unspecified), respiration 52 (units unspecified) and head circumference 35.5 centimeters. On 31-MAY-2013, the patient had a onetime urgent visit since the patient's mother believed that the patient was constipated since the patient had only had 2 bowel movements in the last 3 days. The mother stated that they were not hard balls but soft when asked to describe the bowel movements. The mother also stated that the patient spits up after each feeding. Body mass index was 10.83 (units unspecified), the body surface area was 0.23 (units unspecified), height was 1 feet 10.5 inches, weight 7 pounds 12 oz, temperature 99.4 Fahrenheit rectally, heart rate 168 (units unspecified), respiration 40 (units unspecified) and head circumference 35.5 centimeters. The patient was advised to RTC if no improvement in constipation in 2-3 days, sooner if worse and keep a schedule appointment for 2 months for Early Periodic Screening, Diagnosis, and Treatment (EPSDT). On 03-JUL-2013, the patient underwent a second EPSDT which revealed No growth, development, feeding and sleep concerns. She was diagnosed with oral thrush, bowel movement changes included constipation. Skin problems included seborrhea and atopic dermatitis. Anticipatory Guidance addressed as per the history of present illness section. DTaP, Hib, IPV, Hepatitis B, Rotavirus and Pneumococcal administered. This information discussed with mother and aunt. The Body mass index was 12.61 (units unspecified), the body surface area was 0.26 (units unspecified), height was 1 feet 11.25 inches, weight 9 pounds 11 oz, temperature 99.8 Fahrenheit, heart rate 164 (units unspecified), respiration 46 (units unspecified) and head circumference 38.5 centimeters. On 08-JUL-2013, the patient had a onetime urgent visit, the patient was seen on 03-JUL-2013, and the mother said that the patient didn't have a bowel movement since then. The patient's mother stated that she changed her formula on 03-JUN-2013 because she thought it would help. The patient had her first bowel movement since in waiting room prior to assessment, the mother stated that BM was soft, not hard balls and had tried to using KARO in bottles but has not helped. Body mass index was 12.61 (units unspecified), the body surface area was 0.27 (units unspecified), height was 1 feet 11.75 inches, weight 10 pounds, temperature 100 Fahrenheit, heart rate 172 (units unspecified), respiration 46 (units unspecified) and head circumference 38.5 centimeters. A formula change was attempted and ALIMENTUM would be tried for constipation RTC in 2 weeks to follow up constipation after formula change. RTC prior to appointment date and time if no BM in 2-3 days after changing formula or sooner if worse. On 22-JUL-2013, the patient had a onetime urgent visit due to constipation. The patient was advised to try 1 tbsp of KARO syrup in one bottle daily x 3 days and continue the formula and return to center (RTC) in three days if no Bowel Movement (BM). Body mass index was 14.57 (units unspecified), the body surface area was 0.27 (units unspecified), height was 1 feet 11.0 inches, weight 11 pounds 13 oz, temperature 97.6 Fahrenheit, heart rate 140 (units unspecified) and respiration 36 (units unspecified). On 26-JUL-2013 the patient had a onetime urgent visit since the patient's mother stated that the patient has been spitting up her formula x 2 weeks since starting on ALIMENTUM and was unsure if its projectile vomiting however the mother stated that the patient throws up a lot, hence the patient instructed to burp every two ounces and sit up for at least 30 min after feedings. The Body mass index was 14.83 (units unspecified), the body surface area was 0.27 (units unspecified), height was 1 feet 11.0 inches, weight 11 pounds, temperature 97.6 Fahrenheit, heart rate 148 (units unspecified) and respiration 36 (units unspecified). On 01-AUG-2013, the patient underwent an EPSDT which revealed that the patient continued to burp well after every 2 oz and was propping up after feeding. Body mass index was 15.37 (units unspecified), the body surface area was 0.27 (units unspecified), height was 1 feet 11.0 inches, weight 11 pounds 6.5 oz, temperature 97.2 Fahrenheit and Birth weight 5 pounds 15 oz, heart rate 144 (units unspecified), respiration 36 (units unspecified) and head circumference 16 inches. On 14-AUG-2013, mass index was 15.03 (units unspecified), the body surface area was 0.29 (units unspecified), height was 1 feet 11.7 inches, weight 11 pounds 15 oz, temperature 98.9 Fahrenheit and Birth weight 5 pounds 15 oz. The patient was advised to switch back to Sensitive formula now and form was given to mom. It was reported that the patient was gaining great weight. On 17-SEP-2013, the patient underwent an Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and it was determined that there were No growth, development. Elimination, feeding, skin and sleep concerns. No medical problems. Anticipatory guidance was addressed as per the history of present illness section DTaP, Hib, IPV, Hepatitis 8, Rotavirus, and Pneumococcal administered. Information discussed with mother. The Body mass index was 16.15 (units unspecified), the body surface area was 0.32 (units unspecified), height was 2 feet 0.75 inches, weight 14 pounds 2 oz, temperature 99.2 Fahrenheit rectally, heart rate 138 (units unspecified), respiration 42 (units unspecified) and head circumference 40.5 centimeters. Additional information has been requested.